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Hashmi AA, Mallick BA, Rashid K, Zafar S, Zia S, Malik UA, Sapna F, Anjali F, Vishal F, Irfan M. Clinicopathological Parameters Predicting Malignancy in Phyllodes Tumor of the Breast. Cureus 2023; 15:e46168. [PMID: 37908929 PMCID: PMC10613785 DOI: 10.7759/cureus.46168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Phyllodes tumor (PT) is an uncommon fibroepithelial neoplasm of the breast. It is a biphasic tumor with stromal and epithelial components, with a tendency to recur. Because of its wide range of disease manifestations, it has been subclassified into three categories, i.e., benign, borderline, and malignant, based on several histological parameters. This study was conducted to evaluate the clinicopathological features associated with malignancy in breast PTs. Methods We conducted a retrospective study at the Department of Histopathology at Liaquat National Hospital, Karachi, Pakistan. A total of 146 biopsy-proven cases of PTs were enrolled in the study. Clinical data were obtained from the clinical referral forms. Specimens were obtained from either lumpectomy or simple mastectomy. The specimens obtained were received at the laboratory where after gross examination, paraffin-embedded tissue blocks were prepared, which were sectioned, stained, and studied by a senior histopathologist. Pathological features, such as mitotic count, necrosis, stromal atypia, stromal overgrowth, and heterologous elements, were observed. Based on these features, the PTs were classified into benign, borderline, and malignant tumors. Results The mean age of the PTs in our setup was 40.65 ± 12.17 years with a mean size of 9.40 ± 6.49 cm. Malignant PT was found to be the most prevalent in our population, accounting for 63 (43.2%) cases, followed by borderline (51, 34.9%) and benign (32, 21.9%). A significant association was found between the tumor subtype and patient age, i.e., patients diagnosed with malignant and borderline PTs were found to be of older age (mean 42.82 ± 12.94 and 42.05 ± 11.31 years, respectively) than those diagnosed with benign PTs (mean age 34.12 ± 9.75 years). Moreover, malignant PTs were associated with larger tumor size (mean 11.46 ± 6.08) compared with the other two subtypes. Conclusion We found a significant association among patient age, tumor size, and PT subtype. Therefore, apart from the usual histological parameters, patient age and tumor size are important parameters for predicting the behavior of breast PT and should be considered for management.
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Affiliation(s)
- Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Bakhtawar Allauddin Mallick
- Internal Medicine, Zainab Panjwani Memorial Hospital, Karachi, PAK
- Emergency Medicine, Al-Rayaz Hospital, Karachi, PAK
- Cardiology, Prime Cardiology of Nevada, Las Vegas, USA
| | - Khushbakht Rashid
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Sumbal Zafar
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Shamail Zia
- Pathology, Jinnah Sindh Medical University, Karachi, PAK
| | | | - Fnu Sapna
- Pathology, Albert Einstein College of Medicine, New York, USA
| | - Fnu Anjali
- Internal Medicine, Sakhi Baba General Hospital, Sukkur, PAK
| | - Fnu Vishal
- Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Infectious Diseases, Rochester General Hospital, Rochester, USA
| | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
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Ko SY. Malignant phyllodes tumor of the breast with heterologous osteosarcoma and chondrosarcomatous differentiation: A rare case report with imaging findings. Radiol Case Rep 2023; 18:1982-1988. [PMID: 36994218 PMCID: PMC10040453 DOI: 10.1016/j.radcr.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/18/2023] [Indexed: 03/28/2023] Open
Abstract
Phyllodes tumors of the breast are rare fibroepithelial neoplasms accounting for 0.3%-1.5% of all female breast tumors [1,2]. Malignant transformations occur in 10%-20% of phyllodes tumors, often in the form of stroma. Heterologous osteosarcoma and chondrosarcomatous differentiation of phyllodes tumor are extremely rare, and little is known about their imaging findings. Here, we report a rare case of a 52-year-old woman with no history of previous surgery or radiation therapy, who presented with a rapidly growing right breast mass that was diagnosed as a malignant phyllodes tumor with heterologous osteosarcoma and chondrosarcomatous differentiation. The patient underwent modified radical mastectomy.
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3
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Ureteral tumor with morphological features analogous to phyllodes tumor: a unique case with concomitant urothelial carcinoma. Diagn Pathol 2022; 17:94. [PMID: 36564794 PMCID: PMC9784280 DOI: 10.1186/s13000-022-01277-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Phyllodes tumors belong to a spectrum of biphasic fibroepithelial lesions and are most commonly found in the breast. They are extremely rare in the urinary tract and only one case of bladder phyllodes tumor has been reported. CASE PRESENTATION We present a 69-year-old man with gross hematuria without an apparent cause. Computed tomography-urography and cystoscopic examination revealed a 5 × 4 cm lesion in the right ureteral orifice. He underwent a laparoscopic nephroureterectomy and partial cystectomy. Postoperative pathology confirmed a leaf-like structure consisting of myxoid stroma and peripheral urothelium. Stromal cells were spindle-shaped and stellate in appearance with no conspicuous cytological atypia or mitosis. The outlining urothelium had varying degrees of dysplasia, while in areas with moderate-to-severe dysplasia, active mitotic activity, abnormal giant cells, and focal early infiltration were observed. Overall, this case had the morphological features of benign phyllodes tumors and concomitant invasive urothelial carcinoma inside. The patient remained disease-free at 7 months after surgery. CONCLUSION We report the first ureteral tumor with the morphological characteristics of a phyllodes tumor and concomitant invasive urothelial carcinoma inside. Considering the potential for local recurrence of phyllodes tumors and invasive urothelial carcinoma, long-term clinical and radiological follow-up of such lesions are advisable.
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Esmer AC, Tazeoğlu D, Dağ A. Comparison of Clinical, Histopathological, and Survival Outcomes of Pure and Mixed Mucinous Breast Carcinoma. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Paim SDP, Mello GLD, Martins ALOR, Paz WA. Relato de caso: carcinoma secretório de mama. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.1998v44n3.2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Neste artigo, os autores apresentam o caso de uma paciente portadora de um carcinoma secretório de mama, tipo raro de carcinoma mamário que ocorre com maior freqüência em pacientes jovens. No caso apresentado, uma paciente do sexo feminino com 38 anos de idade, apresentando nódulo mamário com características clínicas de benignidade, foi abordada inicialmente através de uma punção-biópsia por agulha fina (PAAF), cujo exame citológico foi compatível com uma lesão benigna. A paciente foi, então, submetida a uma tumorectomia simples e, ao exame anatomopatológico, foi constatado tratar-se de um carcinoma secretório da mama. Após o diagnóstico de malignidade, optou-se por uma conduta mais conservadora no caso, uma vez que trata-se de um tumor de bom prognóstico, e foi realizada apenas a ampliação das margens cirúrgicas da primeira ressecção. Os autores fazem, ainda, uma breve revisão da literatura, a qual justifica o tratamento conservador instituído.
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6
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Le QH, Mai VT. Malignant phyllodes tumor with synchronous metastases to axillary lymph nodes, lung at the presentation: a case report and literature review. J Surg Case Rep 2021; 2021:rjab302. [PMID: 34336184 PMCID: PMC8321595 DOI: 10.1093/jscr/rjab302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/20/2021] [Indexed: 12/01/2022] Open
Abstract
Phyllodes tumors are rare mesenchymal tumors of breast. Malignant phyllodes tumors can develop metastases to distal organs with spreading hematogenously to most frequent sites as lungs, bone and brain. Regional lymph node enlargement is common but metastasis to lymph node is a very rare phenomenon with prevalence about 1.1–3.8%. In this report, we introduce a case of malignant phyllodes tumor of breast in 57-year-old female patient. Synchronous metastases to axillary lymph nodes and lung were found at the presentation. She was treated with mastectomy combined with axillary lymph node dissection and adjuvant chemotherapy. Axillary lymph node dissection can be considered in case of proven metastatic or suspiciously palpable lymph nodes.
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Affiliation(s)
- Quang Hong Le
- Department of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Vuong The Mai
- Department of Breast Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
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7
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Zhang H, Zhang N, Li Y, Liang Y, Yang Q. Evaluation of efficacy of chemotherapy for mucinous carcinoma: a surveillance, epidemiology, and end results cohort study. Ther Adv Med Oncol 2020; 12:1758835920975603. [PMID: 33425023 PMCID: PMC7758869 DOI: 10.1177/1758835920975603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background In this study, we investigated the impact of chemotherapy on breast cancer-specific survival (BCSS) in patients with mucinous carcinoma using the surveillance, epidemiology, and end results (SEER) database. Methods A large-scale SEER-based retrospective analysis was conducted; 13,329 patients with mucinous carcinoma from 1994 to 2014 were identified. Clinicopathological characteristics were compared using the chi-square test. BCSS curves were generated using the Kaplan-Meier method. The prognostic significance of all demographic and clinicopathological characteristics and treatment patterns were calculated using univariate and multivariate regression analyses. Results Mucinous carcinoma was demonstrated to be less aggressive than invasive ductal carcinoma and predicted a better prognosis in the Kaplan-Meier analysis (hazard ratios = 0.336, 95% confidence interval: 0.308-0.368, p < 0.001). Univariate and multivariate analyses revealed that chemotherapy did not provide any additional benefit for patients with mucinous carcinoma. Predictors for receiving chemotherapy were younger age, estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor receptor 2-positive status, higher grade, larger tumor size, lymph node involvement, radiation reception, and mastectomy. Further subgroup analysis verified that regardless of the hormone receptor (HR) and lymph node (LN) status, patients did not benefit from chemotherapy. Conclusion Our study showed that patients with HR+/LN- mucinous carcinoma did not benefit from chemotherapy and that chemotherapy could not improve the survival of all subtypes of mucinous carcinoma based on large-scale SEER data. These results support that patients with mucinous carcinoma could be exempt from chemotherapy. Additional research is needed to further evaluate the impact of adjuvant treatments, particularly in patients with favorable histology.
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Affiliation(s)
- Hanwen Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Ning Zhang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yaming Li
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Yiran Liang
- Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong, China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan, Shandong 250012, China
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8
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Ding S, Wu J, Lin C, Chen W, Li Y, Shen K, Zhu L. Predictors for Survival and Distribution of 21-Gene Recurrence Score in Patients With Pure Mucinous Breast Cancer: A SEER Population-Based Retrospective Analysis. Clin Breast Cancer 2018; 19:e66-e73. [PMID: 30396812 DOI: 10.1016/j.clbc.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/27/2018] [Accepted: 10/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pure mucinous breast cancer (PMBC) is a rare pathologic type of breast cancer, the prognostic factors of which have not been clearly defined. This study aimed to analyze the prognostic markers and distribution of 21-gene recurrence score (RS) in patients with PMBC. PATIENTS AND METHODS Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, a retrospective analysis of PMBC cases was conducted. Multivariate analyses were used to evaluate the indicators for prognosis and the correlations between RS and traditional clinicopathologic characteristics. Disease was subdivided into 4 molecular phenotypes using estrogen receptor (ER) status and tumor grade. RESULTS Of the 8048 patients, most had ER-positive and node-negative tumors. Multivariate analysis revealed that molecular phenotype as well as age, race, tumor size, and lymph node status was an independent prognostic factor for patients with PMBC (P < .05). The 5-year breast cancer-specific survival of patients among different phenotypes was significantly different (97.9% for ER-positive and grade I tumor, 96.9% for ER-positive and grade II-III tumor, 96% for ER-negative and grade I tumor, 90.1% for ER-negative and grade II-III tumors, P < .001). The proportions of patients categorized into low, intermediate, and high RS risk group were 64.9%, 31.9%, and 3.2%, respectively. Grade, progesterone receptor status, and age were identified as independent variables associated with RS. CONCLUSION PMBC had favorable biological features and relatively good prognosis. Molecular phenotype as well as age, race, tumor size, and lymph node status were independent prognostic markers. Furthermore, age, progesterone receptor status, and grade could independently predict RS.
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MESH Headings
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Combined Modality Therapy
- Female
- Genetic Testing/methods
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- SEER Program
- Survival Rate
- Transcriptome
- Young Adult
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Affiliation(s)
- Shuning Ding
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caijin Lin
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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9
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Ciatto S, Cataliotti L, Cardona G, Bianchi S. Risk of Infiltrating Breast Cancer Subsequent to Lobular Carcinoma in Situ. TUMORI JOURNAL 2018; 78:244-6. [PMID: 1466079 DOI: 10.1177/030089169207800405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report on a retrospective consecutive multicentric series of 60 cases with histologic evidence of lobular carcinoma in situ (LCIS), followed for an average of 5.3 years. In the course of the follow-up, ipsilateral LCIS or infiltrating carcinoma occurred in 3 or 5 cases, respectively. Two LCIS reoccurrences and all ipsilateral infiltrating carcinomas were observed in 37 patients treated by limited surgery. Contralateral synchronous or metachronous carcinoma was observed in 3 or 2 cases, respectively (intraductal = 3, infiltrating = 2). Three patients died of breast cancer (2 with Ipsilateral, 1 with ipsilateral and contralateral infiltrating carcinoma). The study confirms the higher risk of ipsilateral and contralateral cancer in LCIS patients and warns about the possible hazards of limited surgery in these cases.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Università di Firenze, Italy
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10
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Hlupić L, Jakić-Razumović J, Bozikov J, Corić M, Belev B, Vrbanec D. Prognostic Value of Different Factors in Breast Carcinoma. TUMORI JOURNAL 2018; 90:112-9. [PMID: 15143983 DOI: 10.1177/030089160409000123] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The aggressive biological behavior of invasive and metastatic cancer is considered to be the most insidious and life-threatening aspect for breast cancer patients. It is mostly the result of changes in many molecular characteristics of tumor cells, including alterations in the mechanisms controlling cell growth and proliferation. Aim The aim of this retrospective study was to identify predictors of aggressive biological behavior and metastatic potential in breast carcinoma among a number of intrinsic bio-markers of tumor cells such as steroid receptors and oncogene and tumor suppressor gene products. Methods Routine formalin-fixed, paraffin-embedded tumor samples were used and sections were stained immunohistochemically with the DAKO Strept ABC method to determine the expression of estrogen receptors (ER), progesterone receptors (PgR), HER-2/neu, bcl-2, Ki-67, p53 and nm23 in 192 consecutive breast carcinoma patients. The results of the quantitative immunohistochemical assays were correlated with clinical and histological data such as patient age, overall survival, tumor size, axillary lymph node status, hystological type, tumor grade, Nottingham prognostic index (NPI) and therapeutic regimens. Results Univariate analysis revealed that survival was significantly longer for patients with small tumors (P = 0.007), lower tumor grade (P = 0.021), negative axillary lymph nodes (P = 0.002), presence of nm23 protein (P = 0.002), and for patients treated with adjuvant hormonal therapy (P = 0.010). In multivariate analysis the independent factors positively affecting survival were absence of axillary lymph node metastases (P = 0.002), nm23 expression (P = 0.009) and hormonal therapy (P = 0.050). Among patients with positive axillary nodes there was a significantly higher survival rate in patients with nm23 expression compared with nm23-negative patients (P <0.001). Conclusion Identification of a subset of node-positive breast cancer patients with a more favorable prognosis according to nm23 expression might be clinically useful.
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Affiliation(s)
- Ljiljana Hlupić
- Department of Pathology, Clinical Hospital Center Zagreb, Croatia.
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11
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Ciatto S, Bonardi R, Cataliotti L, Cardona G. Intraductal Breast Carcinoma. Review of a Multicenter Series of 350 Cases. TUMORI JOURNAL 2018; 76:552-4. [PMID: 2178285 DOI: 10.1177/030089169007600607] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A multicentrer series of 350 intraductal breast cancers (DCIS) is reported. Mammography was the most sensitive test but suspicion arose only at palpation in 13% of cases whereas in 10% of cases biopsy was recommended for a benign lesion and DCIS was an unexpected finding. Mammography, physical examination and cytology must be combined to achieve optimal sensitivity. Systematic biopsy of apparently benign masses would increase DCIS detection rates but the cost-effectiveness of such a policy is questionable. A trend of conservative surgery was evident over time (from 1968-79, 28%; 1985-1989, 50%) but breast irradiation followed only in one fourth of the cases. The local recurrence rate was significantly higher in cases of limited surgery (with or without irradiation) with respect to mastectomy (1.2 vs 0.2 × 100 patient-years at risk). Most recurrences (7 of 8) in the conserved breast were infiltrating, but no recurrence was seen in subclinical DCIS cases. Three patients died of breast cancer after local recurrence in the conserved breast (2 cases) or mastectomy scar (1 case). Eligibility for conservative surgery of DCIS needs to be carefully discussed to avoid under-treatment. Contralateral breast cancer was recorded in 44 cases and the incidence of further metachronous cancer to the other breast was ten times higher than expected in normal breasts. Four patients died of contralateral breast cancer, free of ipsilateral recurrence. A careful follow-up of the contralateral breast in DCIS cases looks as important as surveillance of the conserved breast.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, University, Florence, Italy
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12
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Pilotti S, Rilke F, Delpiano C, Di Pietro S, Guzzon A. Problems in Fine-Needle Aspiration Biopsy Cytology of Clinically or Mammographically Uncertain Breast Tumors. TUMORI JOURNAL 2018; 68:407-12. [PMID: 7179495 DOI: 10.1177/030089168206800509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From June 1978 to December 1980 at the Istituto Nazionale Tumori of Milano, a fine-needle aspiration biopsy was performed on each of 4834 cases of palpable mammary nodules, the large majority of which were clinically and mammographically suspicious for cancer and only a small part clinically definitely positive. Of these, 1173 underwent surgery at this institution, and 534 (45.5%) had a histologically proven carcinoma. The aspirations were performed by individuals different from those who read the cytologic smears. The aspirations were never repeated, and methods for the retrieval of cells were never applied. Under the circumstances, sensitivity was 0.67, specificity 0.98, and the predictive value for positive results 0.97. The high percentage of inadequate samples (25.5%) influenced the low sensitivity. The few false-positive results occurred exclusively during the first year. Frozen sections can be avoided in those cases (about 50%) with definitely positive cytologic diagnosis by the application of strict criteria. The intrinsc incapability of cytology to yield any information on the extent and the invasiveness of a malignant lesion does not seem to effect its pre-operatory conclusiveness.
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13
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Nuti M, Turchi V, Rughetti A, Viacava P, Masci A, Castagna M, Frati L. Characterization of Monoclonal Antibody 436 Recognizing the ARG-PRO-ALA-PRO Sequence of the Polymorphic Epithelial Mucin (PEM) Protein Core in Breast Carcinoma Cells. Int J Biol Markers 2018. [DOI: 10.1177/172460089200700201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epithelial mucins have obtained increasing clinical relevance since they were found in the serum of cancer patients and were shown to be elevated in metastatic disease. We report here the characterization of the monoclonal antibody (MAb) 436 which recognises the protein core of the polymorphic epithelial mucin (PEM) of the human breast. MAb 436 was generated by immunizing Balb/c mice with membrane-enriched fractions prepared from metastatic lesions in the axillary lymph nodes. The antigenic determinant recognized by the MAb 436 is expressed on the surface of breast cancer cells and was measured by ELISA on all of 50 cytosol preparations of primary breast tumors. Immunohistochemistry showed 98% of primary and 100% of metastatic breast cancer lesions to be positive with the 436 antigenic determinant expressed both in the cytoplasm and at the plasma membrane level of the tumor cells. Moreover, the antigen was expressed in a homogeneous fashion (80-100% of the total number of tumor cells) in more than 60% of the tumors. Reactivity with normal tissues was rare and scattered and restricted to glandular structures particularly at the luminal border level except for the distal and collecting tubules of adult and fetal kidney, where a cytoplasmic 436 antigen distribution was observed. Other cancers proved positive but the reactivity was always variable and heterogeneous. The antigen recognized by MAb 436 appears in Western Blotting as a Mr of more than 200,000 daltons protein resolved in two bands. Epitope mapping experiments using overlapping octapeptides in the repeat unit of the PEM identified in the RPAP (Arg-Pro-Ala-Pro) sequence the binding site of the 436 antigen. With the selective reactivity shown and the homogeneous expression of the corresponding epitope in breast cancer cells of primary and metastic lesions, the MAb 436 represents a good reagent with potential application in the diagnosis and therapy of breast cancer.
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Affiliation(s)
- M. Nuti
- Department of Experimental Medicine, University of Roma, Roma
| | - V. Turchi
- Department of Experimental Medicine, University of Roma, Roma
| | - A. Rughetti
- Department of Experimental Medicine, University of Roma, Roma
| | - P. Viacava
- Institute of Pathological Anatomy, University of Pisa, Pisa - Italy
| | - A.M. Masci
- Department of Experimental Medicine, University of Roma, Roma
| | - M. Castagna
- Institute of Pathological Anatomy, University of Pisa, Pisa - Italy
| | - L. Frati
- Department of Experimental Medicine, University of Roma, Roma
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14
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Abstract
OBJECTIVE The purpose of this study is to evaluate the sonographic and histopathologic features distinguishing benign from borderline and malignant phyllodes tumors. MATERIALS AND METHODS The ultrasound examinations of women with pathologically proven phyllodes tumors from 2004 to 2011 were retrospectively reviewed. The sonographic features of benign, borderline, and malignant phyllodes tumors were compared and analyzed using the American College of Radiology's BI-RADS ultrasound lexicon. Fisher exact test and Wilcoxon rank sum test were used for statistical analysis. RESULTS Fifty-nine women were included in the study; 28 benign (47%), 19 malignant (32%), and 12 borderline (20%) phyllodes tumors were identified. Significant univariate predictors of increased risk of borderline or malignant phyllodes tumors were patient age greater than 55 years (p = 0.014), irregular lesion shape (p = 0.011), and longest lesion dimension greater than 7 cm (p = 0.0022) at sonography. No significant differences were observed in lesion margins, boundaries, echo patterns, or posterior acoustic features. CONCLUSION There is substantial overlap in the sonographic features of benign and borderline or malignant phyllodes tumors. Understanding the clinical and sonographic features of phyllodes tumors may aid the radiologist in predicting biological behavior, including the likelihood of benign versus borderline or malignant phyllodes tumors at pathologic analysis.
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15
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Successful Resection of Large Solitary Pulmonary Metastasis from a Malignant Phylloides Breast Tumor: A Rare Phenomemon. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Roberts N, Runk DM. Aggressive malignant phyllodes tumor. Int J Surg Case Rep 2015; 8C:161-5. [PMID: 25697402 PMCID: PMC4353966 DOI: 10.1016/j.ijscr.2014.12.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/31/2014] [Indexed: 11/30/2022] Open
Abstract
Phyllodes tumor of breast could be either benign or malignant variety and they can grow into very large sizes and distort the breast. WHO classifies tumors into benign, borderline and malignant and it is the best methods to predict the local recurrence, distant metastasis or bath after resection. Borderline and malignant disease should have close follow up; as some of these tumors can rapidly change and metastasize.
Introduction Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3–0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10–30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount. Presentation of case We present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31 cm in diameter and weighed over 10 kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office. Conclusion Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.
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Affiliation(s)
- Nathan Roberts
- Jewish Hospital Department of Surgery, 4777 E. Galbraith Road, Cincinnati, OH 45236, USA.
| | - Dianne M Runk
- Jewish Hospital Department of Surgery, 4777 E. Galbraith Road, Cincinnati, OH 45236, USA
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Immediate implant breast reconstruction with acellular dermal matrix for treatment of a large recurrent malignant phyllodes tumor. Aesthetic Plast Surg 2014; 38:373-8. [PMID: 24570179 DOI: 10.1007/s00266-014-0283-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Phyllodes tumors (PT) are rare fibroepithelial breast tumors representing less than 1 % of all breast malignancies. These tumors are unpredictable and fast growing with a high local recurrence rate, making this disease challenging to treat. Previous literature focused on surgical resection, and breast reconstruction following a mastectomy in patients with PT is rarely addressed. We report a case of a recurrent malignant PT treated with a nipple-sparing mastectomy followed by immediate single-stage silicone implant breast reconstruction. While PT is a rare breast malignancy that presents challenges with both surgical resection and reconstruction, we demonstrate that nipple-sparing mastectomy with immediate implant breast reconstruction with AlloMax is curative and can offer an appealing cosmetic option. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Mituś JW, Blecharz P, Reinfuss M, Kulpa JK, Skotnicki P, Wysocki WM. Changes in the clinical characteristics, treatment options, and therapy outcomes in patients with phyllodes tumor of the breast during 55 years of experience. Med Sci Monit 2013; 19:1183-7. [PMID: 24356679 PMCID: PMC3871490 DOI: 10.12659/msm.889687] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Data from the literature suggests that the clinical picture of phyllodes tumor (PT) of the breast, as well as treatment options and perhaps therapy outcomes, have significantly changed. The aim of this work was to review these changes by analysis of consecutive patients with PT over a 55-year period at a single institution. Material/Methods From 1952 to 2007, 280 women with PT were treated surgically at the Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Center in Cracow. Age, size of breast tumor, microscopic type, extent of surgery, and therapy outcomes were compared between 2 groups: 190 patients treated from 1952 to 1991 vs 90 patients treated from 1992 to 2007. Results The results show that the 1992–2007 group compared to the 1952–1991 included more patients <50 years of age, with tumor <5 cm in diameter, undergoing breast-conserving therapy, as well as no evidence of disease at 5-year survival had increased and this change was statistically significant. In addition, malignant PT cases had decreased in frequency. Conclusions The results of this study show that patients with PT are increasingly younger, the breast tumors at diagnosis are smaller, malignant PT is becoming less frequent, and BCT is now the treatment of choice. Most importantly, the general treatment outcomes are significantly better.
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Affiliation(s)
- Jerzy Władysław Mituś
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Paweł Blecharz
- Department of Gynecological Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Marian Reinfuss
- Department of Radiotherapy, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Jan Kanty Kulpa
- Department of Clinical Biochemistry, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Piotr Skotnicki
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
| | - Wojciech Maria Wysocki
- Department of Surgical Oncology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland
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Gnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998-2009. Ann Surg Oncol 2013; 21:1222-30. [PMID: 24306659 DOI: 10.1245/s10434-013-3395-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Malignant phyllodes tumors of the breast have traditionally been treated with surgical excision. Recently, the use of adjuvant radiotherapy has been advocated to reduce the risk of local recurrence; however, this recommendation is controversial in the absence of consistent outcome data. We hypothesize that there has been a trend toward increased utilization of adjuvant radiotherapy for malignant phyllodes tumors despite its uncertain effect on outcomes. METHODS Using the National Cancer Data Base, predictors of radiotherapy utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan-Meier and Cox regression models were generated to determine the effect of radiotherapy on local recurrence (LR), disease-free survival (DFS), and overall survival (OS). RESULTS Of the 3,120 patients with malignant phyllodes, 57 % underwent breast conservation surgery and 42 % underwent mastectomy. Overall, 14.3 % of women received adjuvant radiotherapy. Utilization of radiotherapy doubled over the study period (9.5 % in 1998-1999 vs. 19.5 % in 2008-2009, p < 0.001). Women were significantly more likely to receive radiotherapy if they were diagnosed later in the study, were age 50-59 years old, had tumors >10 cm, or had lymph nodes removed. For the 1,774 patients with available recurrence data, overall recurrence was 14.1 %, and LR was 5.9 %. In adjusted models, adjuvant radiotherapy reduced LR (aHR 0.43, 95 % CI 0.19-0.95) but did not impact DFS or OS after 53 months' median follow-up. CONCLUSIONS Utilization of adjuvant radiotherapy for malignant phyllodes doubled from 1998 to 2009. Radiotherapy significantly reduced LR but had no effect on DFS or OS.
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Affiliation(s)
- Jennifer L Gnerlich
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
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A case of large phyllodes tumor causing "rupture" of the breast: a unique presentation. Case Rep Oncol Med 2013; 2013:871292. [PMID: 23762692 PMCID: PMC3666329 DOI: 10.1155/2013/871292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/28/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. Phyllodes tumors are rare fibroepithelial tumors which constitute less than 1% of all known breast neoplasms. The importance of recognizing these tumors lies in the need to differentiate them from fibroadenomas and other benign breast lesions to avoid inappropriate surgical management. We report a case of large phyllodes tumor which caused rupture of the breast and presented as an external fungating breast mass, a presentation which is exceedingly rare. Case Presentation. A 32-year-old female presented with a 1-year history of a mass in her right breast and eruption of the mass through the skin for the last 3 months. On physical examination, an ulcerated, irregular, and nodular mass measuring 9 × 8 cms was found hanging in the lower and outer quadrant of the right breast. Ultrasonography revealed an exophytic mass with heterogeneous echotexture and vascularity. Under general anesthesia, the tumor was excised. The resected specimen was 9.5 × 8.5 × 4.5 cm in size and the tumor was not invasive to the surrounding tissues. Histological examination confirmed a benign case of Phyllodes tumor. Conclusion. Clinicians should be aware of the myriad ways in which Phyllodes can present. A rapidly growing breast mass in a female should raise strong suspicion for Phyllodes. It is necessary to differentiate it from fibroadenomas to avoid inappropriate surgical management which may lead to local recurrence.
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Malignant Phyllodes Tumor of the Breast Metastasizing to the Vulva: (18)F-FDG PET-CT Demonstrating Rare Metastasis from a Rare Tumor. Nucl Med Mol Imaging 2012; 46:232-3. [PMID: 24900068 DOI: 10.1007/s13139-012-0154-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022] Open
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Park HL, Kwon SH, Chang SY, Huh JY, Kim JY, Shim JY, Lee YH. Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy. J Breast Cancer 2012; 15:224-9. [PMID: 22807941 PMCID: PMC3395747 DOI: 10.4048/jbc.2012.15.2.224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/20/2012] [Indexed: 01/11/2023] Open
Abstract
Purpose Percutaneous removal of benign breast tumors using ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible and safe method without serious complications. The aim of this study was to evaluate the efficacy and safety of the VABB in the treatment of benign phyllodes tumors, and to identify whether or not surgical re-excision is necessary for benign phyllodes tumors diagnosed and excised by VABB. Methods From January 2003 to December 2011, a total of 6,923 VABB were performed in 5,434 patients. Out of 6,923 lesions, 53 were benign phyllodes tumors. Among these, 31 lesions, with a follow-up period of longer than 24 months, were enrolled in this study. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. The mean follow-up period was 75.9±13.5 months (range, 24-94 months). Results The mean patient age at presentation was 31.6±9.4 years. The mean size of the lesion was 1.60±0.88 cm. The majority of lesions, 74.2% (23 cases), were palpable, and 25.8% (8 cases) were non-palpable. Twenty-two lesions (71.0%) were classified as Breast Imaging Reporting and Data System category 3, and nine lesions (29.0%) were classified as category 4a, by ultrasonography. During the follow-up period, local recurrence developed in one lesion, making the local recurrence rate 3.2%. Conclusion If a benign phyllodes tumor is diagnosed, and sufficiently excised by VABB, observing the clinical course may be considered as an alternative to performing immediate wide local excision; this is the case despite the fact that it would need to be observed for a prolonged period of time.
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Affiliation(s)
- Hai-Lin Park
- Department of Surgery, Kangnam CHA Hospital, CHA University College of Medicine, Seoul, Korea
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Cao AY, He M, Liu ZB, Di GH, Wu J, Lu JS, Liu GY, Shen ZZ, Shao ZM. Outcome of pure mucinous breast carcinoma compared to infiltrating ductal carcinoma: a population-based study from China. Ann Surg Oncol 2012; 19:3019-27. [PMID: 22451233 DOI: 10.1245/s10434-012-2322-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Pure mucinous breast carcinoma (PMBC) is a rare pathologic finding. Few studies have addressed the biologic features of PMBC and prognostic factors among patients with this disease. We performed a study to compare PMBC and invasive ductal carcinoma (IDC) by means of a large database to reliably assess the biologic phenotype and clinical behavior of PMBC. METHODS A total of 2,511 patients who met the inclusion criteria were identified from 1999 to 2010; 2,202 patients had pure IDC and 309 had PMBC. Clinical and biologic features, overall survival, and recurrence/metastasis-free survival (RFS) were compared for both groups. RESULTS PMBC had favorable characteristics including smaller size, lower rates of lymph node positivity, lower stage, higher expression of hormone receptors, and less HER2 overexpression. Patients with PMBC had better 10-year RFS (71 %) than patients with IDC (64 %). Multivariate analysis revealed that node status and tumor, node, metastasis system (TNM) stage were statistically significant prognostic factors for survival. RFS curves stratified for node status revealed a highly significant difference between node negative and node positive patients. Additionally, patients with PMBC underwent breast-conserving surgery (BCS) more frequently than patients with IDC, and the 5-year overall survival rate of the BCS group was not significantly different from the total mastectomy group. CONCLUSIONS PMBC in Chinese women showed less aggressive behavior and had a better prognosis than IDC, and this favorable outcome was maintained after 10 years. Node status and TNM stage appeared to be the most significant predictors of worse prognosis. BCS should be preferred over mastectomy in the treatment of early-stage PMBC.
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Affiliation(s)
- A-Yong Cao
- Breast Cancer Institute, Cancer Hospital/Cancer Institute, Fudan University, Shanghai, People's Republic of China
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Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ, Yang JH. Mucinous carcinoma of the breast in comparison with invasive ductal carcinoma: clinicopathologic characteristics and prognosis. J Breast Cancer 2011; 14:308-13. [PMID: 22323918 PMCID: PMC3268928 DOI: 10.4048/jbc.2011.14.4.308] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/17/2011] [Indexed: 12/02/2022] Open
Abstract
Purpose Mucinous carcinoma (MC) of the breast is a rare histologic type of mammary neoplasm. The objective of this study was to evaluate the long-term disease-free survival (DFS) and overall survival (OS) of MC. Methods We conducted a retrospective analysis of all MC cases reported to a database between 1994 and 2010. Clinicopathological characteristics and survival of 268 MC cases were reviewed and compared with 2,455 invasive ductal carcinoma-not otherwise specified (IDC-NOS) cases. Results The MC cases were of a younger age, involved less lymph nodes, lower stage, more expression of hormonal receptors, and less HER2 overexpression compared to the IDC-NOS cases. The 5-year DFS rate for MC was 95.2% compared to 92.0% for IDC-NOS. The 5-year OS rate for MC was 98.9% compared to 94.9% for IDC-NOS. Multivariate analysis using Cox regression revealed that the mucinous type was a significant prognostic factor for DFS with lower nodal status (N stage) and hormonal therapy. For OS, only N stage was the most significant prognostic factor followed by adjuvant chemotherapy and adjuvant hormonal therapy. Conclusion MC was shown to be associated with a better DFS than IDC-NOS, but it had a similar OS. Nodal status and adjuvant therapy appear to be more significant predictors of prognosis than histologic subtype.
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Affiliation(s)
- Soo Youn Bae
- Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Giant phyllodes tumors of the breast: imaging findings with clinicopathological correlation in 14 cases. Clin Imaging 2011; 35:102-7. [PMID: 21377047 DOI: 10.1016/j.clinimag.2010.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 01/10/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe imaging features in giant phyllodes tumors (GPTs) with radiology-pathologic correlations. MATERIALS AND METHODS Surgically confirmed 14 GPTs of the breast were retrospectively reviewed with ultrasound, mammograms, computed tomography, magnetic resonance imaging, and positron emission tomography. RESULTS The most GPTs showed circumscribed and lobulated masses with cystic necrosis. Five cases of core needle biopsy results were benign other than GPTs. CONCLUSION Radiology-pathologic correlation in GPTs is essential, due to differences of pathologic results (5/14 in our study) between core biopsy and surgical pathology.
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Focus on haematogenous dissemination of the malignant cystosarcoma phylloides: institutional experience. Arch Gynecol Obstet 2010; 283:591-6. [DOI: 10.1007/s00404-010-1746-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/19/2010] [Indexed: 11/30/2022]
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Yoo JL, Woo OH, Kim YK, Cho KR, Yong HS, Seo BK, Kim A, Kang EY. Can MR Imaging Contribute in Characterizing Well-circumscribed Breast Carcinomas? Radiographics 2010; 30:1689-702. [DOI: 10.1148/rg.306105511] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pure Mucinous Carcinoma of the Breast: a Clinicopathologic Analysis with 56 Patients. ACTA ACUST UNITED AC 2010; 25:115-8. [DOI: 10.1016/s1001-9294(10)60033-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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MR imaging findings of benign and malignant circumscribed breast masses: part 1. Solid circumscribed masses. Jpn J Radiol 2009; 27:395-404. [DOI: 10.1007/s11604-009-0359-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 08/05/2009] [Indexed: 10/19/2022]
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Barth RJ, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol 2009; 16:2288-94. [PMID: 19424757 DOI: 10.1245/s10434-009-0489-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 04/03/2009] [Accepted: 04/04/2009] [Indexed: 01/04/2023]
Abstract
BACKGROUND Malignant phyllodes tumors of the breast are unusual neoplasms, with an incidence of approximately 500 cases annually in the United States. Published local recurrence rates after margin-negative breast-conserving resections of borderline malignant and malignant phyllodes tumors are unacceptably high, at 24 and 20%, respectively. It is uncertain whether radiotherapy after resection of phyllodes tumors is beneficial. METHODS We prospectively enrolled patients who were treated with a margin-negative breast-conserving resection of borderline malignant or malignant phyllodes tumors to adjuvant radiotherapy. The primary endpoint was local recurrence. RESULTS Forty-six women were treated at 30 different institutions. The mean patient age was 49 years (range, 18-76 years). Thirty patients (65%) had malignant phyllodes tumors; the rest were borderline malignant. The mean tumor diameter was 3.7 cm (range, .8-11 cm). Eighteen patients had a negative margin on the first excision. The median size of the negative margin was .35 cm (range, <.1-2 cm). Twenty-eight patients underwent a re-excision because of positive margins in the initial resection. Two patients died of metastatic phyllodes tumor. During a median follow-up of 56 months (range, 12-129 months), none of the 46 patients developed a local recurrence (local recurrence rate, 0%; 95% confidence interval, 0-8). CONCLUSIONS Margin-negative resection combined with adjuvant radiotherapy is very effective therapy for local control of borderline and malignant phyllodes tumors. The local recurrence rate with adjuvant radiotherapy was significantly less than that observed in reported patients treated with margin-negative resection alone.
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Affiliation(s)
- Richard J Barth
- Department of Surgery, Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Blazicević V, Staklenac B, Kristek J, Pajtler M, Krajinović Z, Stimac D, Ivezić Z, Kotromanović Z, Tomas I, Biljan M. "Signet-ring" cell invasive lobular carcinoma of the breast - accidental finding associated with intraductal papilloma: a case report. CASES JOURNAL 2009; 2:130. [PMID: 19200374 PMCID: PMC2644296 DOI: 10.1186/1757-1626-2-130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 02/06/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND A 57-year old woman had only unilateral milky dischardge of the right breast. Clinical and mammography findings were normal. CASE PRESENTATION Cytological diagnosis of intraductal papilloma was established which was galactographically confitmed and patient underwent to surgery. Ductulolobular segmentectomy was made. Histopathologically beside intraductal papilloma numerous single dispread malignant "signet ring" cells in the fibrous retromammilary stroma were found. Imunohistochemically findings were: cytokeratin 8 positive, ER H-score 80, PR H-score 50, HER-2/neu negative. Diagnosis of "signet ring" cell lobular invasive carcinoma was made, followed by mastectomy, axillary limphadectomy and contra lateral breast biopsy. CONCLUSION Residual tumor were found only in the breast tissue, while axillary lymph nodes and contra lateral breast biopsy were negative. Patient underwent to oncology therapy.
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Affiliation(s)
- Valerija Blazicević
- Department of Pathology and Forensic Medicine, Clinical Hospital Osijek, Osijek, Croatia.
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Tutt A, Wang A, Rowland C, Gillett C, Lau K, Chew K, Dai H, Kwok S, Ryder K, Shu H, Springall R, Cane P, McCallie B, Kam-Morgan L, Anderson S, Buerger H, Gray J, Bennington J, Esserman L, Hastie T, Broder S, Sninsky J, Brandt B, Waldman F. Risk estimation of distant metastasis in node-negative, estrogen receptor-positive breast cancer patients using an RT-PCR based prognostic expression signature. BMC Cancer 2008; 8:339. [PMID: 19025599 PMCID: PMC2631011 DOI: 10.1186/1471-2407-8-339] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 11/21/2008] [Indexed: 11/10/2022] Open
Abstract
Background Given the large number of genes purported to be prognostic for breast cancer, it would be optimal if the genes identified are not confounded by the continuously changing systemic therapies. The aim of this study was to discover and validate a breast cancer prognostic expression signature for distant metastasis in untreated, early stage, lymph node-negative (N-) estrogen receptor-positive (ER+) patients with extensive follow-up times. Methods 197 genes previously associated with metastasis and ER status were profiled from 142 untreated breast cancer subjects. A "metastasis score" (MS) representing fourteen differentially expressed genes was developed and evaluated for its association with distant-metastasis-free survival (DMFS). Categorical risk classification was established from the continuous MS and further evaluated on an independent set of 279 untreated subjects. A third set of 45 subjects was tested to determine the prognostic performance of the MS in tamoxifen-treated women. Results A 14-gene signature was found to be significantly associated (p < 0.05) with distant metastasis in a training set and subsequently in an independent validation set. In the validation set, the hazard ratios (HR) of the high risk compared to low risk groups were 4.02 (95% CI 1.91–8.44) for the endpoint of DMFS and 1.97 (95% CI 1.28 to 3.04) for overall survival after adjustment for age, tumor size and grade. The low and high MS risk groups had 10-year estimates (95% CI) of 96% (90–99%) and 72% (64–78%) respectively, for DMFS and 91% (84–95%) and 68% (61–75%), respectively for overall survival. Performance characteristics of the signature in the two sets were similar. Ki-67 labeling index (LI) was predictive for recurrent disease in the training set, but lost significance after adjustment for the expression signature. In a study of tamoxifen-treated patients, the HR for DMFS in high compared to low risk groups was 3.61 (95% CI 0.86–15.14). Conclusion The 14-gene signature is significantly associated with risk of distant metastasis. The signature has a predominance of proliferation genes which have prognostic significance above that of Ki-67 LI and may aid in prioritizing future mechanistic studies and therapeutic interventions.
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Affiliation(s)
- Andrew Tutt
- Breakthrough Breast Cancer Research Unit, King's College, London, UK.
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Di Saverio S, Gutierrez J, Avisar E. A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat 2008; 111:541-7. [PMID: 18026874 DOI: 10.1007/s10549-007-9809-z] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 10/30/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pure mucinous breast carcinoma (PMBC) is a rare histologic type of mammary neoplasm. It has been associated with a better short-term prognosis than infiltrating ductal carcinoma (IDC) but identical long-term survival curves have been reported. The value of tumor size for TNM staging has been challenged because of the mucin content of the lesions. This study presents a large PMBC series with 20 years follow up as compared to IDC. The relative significance of a variety of common prognostic factors is calculated for this uncommon histology. MATERIALS AND METHODS A retrospective analysis of all PMBC cases reported in the SEER database between 1973 and 2002 was conducted. Overall survival (OS) and disease specific survival (DSS) were calculated at 5, 10, 15 and 20 years of follow up. Those curves were compared with all the IDC cases reported into the database during the same period. The prognostic significance of gender, race, laterality, age at diagnosis, T and N status, estrogen and progesterone receptors and administration of radiation therapy was calculated by univariate and multivariate analysis. RESULTS There were 11,422 PMBC patients reported. The median age at diagnosis was 71 years (Range 25-85). Fifty three percent of the tumors were well differentiated, 38% were moderately differentiated and the remaining 9% were poorly differentiated or anaplastic. The majority of the tumors were located in the upper outer quadrant (44%) the other 56% were roughly evenly divided between the upper inner, lower inner, lower outer and central quadrants. Eighty six percent of the patients had only localized disease at the time of surgery without nodal or distant disease while 12% had regional nodal involvement and 2% had distant metastases. The PMBC cases showed a better differentiation with lesions of lesser grade and more frequent ER/PR expression, smaller size and lesser nodal involvement when compared to the IDC cases of the same period. Kaplan Meier survival curves revealed a 5 years. breast cancer specific survival rate of 94%. Although slowly decreasing with time, 10, 15 and 20 years survival were 89%, 85% and 81% respectively compared to 82% (5 year), 72% (10 year), 66% (15 year) and 62% (20 year) for IDC. There were no significant differences in overall survival. Multivariate analysis by Cox regression revealed the nodal status (N) to be the most significant prognostic factor followed by age, tumor size (T), progesterone receptors and nuclear grade. Disease specific survival curves stratified for nodal status revealed a highly significant difference between node negative and node positive patients. The addition of radiation therapy after surgery did not significantly improve overall survival. CONCLUSIONS This large retrospective comparative analysis confirms the less aggressive behavior of PMBC compared to IDC. This favorable outcome is maintained after 20 years. This tumor presents typically in older patients and is rarely associated with nodal disease. Positive nodal status appears to be the most significant predictor of worse prognosis.
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MESH Headings
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Proportional Hazards Models
- Retrospective Studies
- Risk Assessment
- Risk Factors
- SEER Program
- Time Factors
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Salomone Di Saverio
- Department of Surgery, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Park S, Kim JH, Kim S, Park BW, Lee KS. Clinicopathological Characteristics and Prognostic Factors of Papillary Carcinoma of the Breast. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Hee Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seokmo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Woo Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyong Sik Lee
- Department of Surgery, Pochon CHA University College of Medicine, Seongnam, Korea
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Ganti S, Svennevik E, Ali FS, Anikin V. Successful Resection of Giant Solitary Pulmonary Metastasis From a Phyllodes Tumor. Ann Thorac Surg 2007; 84:1750-2. [DOI: 10.1016/j.athoracsur.2007.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 05/22/2007] [Accepted: 06/05/2007] [Indexed: 10/22/2022]
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Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer 2006; 107:2127-33. [PMID: 16998937 DOI: 10.1002/cncr.22228] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Malignant phyllodes tumor is a rare and potentially aggressive breast neoplasm. Little information is available regarding the optimal management of these lesions and rarer still are data regarding survival. The current study used a large population database to determine prognostic factors that predict cause-specific survival (CSS). METHODS Data were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) for the years 1983-2002. Women receiving resection for primary nonmetastatic malignant phyllodes tumor of the breast were included (n = 821). Analyses of patient, pathologic, and treatment characteristics were performed using univariate and multivariate Cox regression analyses for the CSS endpoint. RESULTS With a median follow-up of 5.7 years, CSS was 91%, 89%, and 89%, at 5, 10, and 15 years, respectively. Mastectomy was performed in 428 women (52%) and wide excision or lumpectomy in 393 (48%). Women undergoing mastectomy were significantly older (P = .004) and had larger tumors (P = .009). Wide excision was associated with equivalent or improved CSS relative to mastectomy on univariate and multivariate analyses. Older age predicted for cause-specific mortality on multivariate analysis. Adjuvant radiotherapy (RT) predicted for worse CSS when implemented compared with surgery alone. CONCLUSIONS Mastectomy was not found to provide a benefit in CSS compared with wide excision in malignant phyllodes tumor of the breast. Women undergoing wide excision had at the minimum similar cancer-specific mortality compared with those who received mastectomy. The role of adjuvant RT is uncertain and requires further investigation.
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Affiliation(s)
- O Kenneth Macdonald
- Department of Radiation Oncology, Huntsman Cancer Hospital at the University of Utah, Salt Lake City, Utah 84112-5560, USA.
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Okafuji T, Yabuuchi H, Sakai S, Soeda H, Matsuo Y, Inoue T, Hatakenaka M, Takahashi N, Kuroki S, Tokunaga E, Honda H. MR imaging features of pure mucinous carcinoma of the breast. Eur J Radiol 2006; 60:405-13. [PMID: 16963218 DOI: 10.1016/j.ejrad.2006.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 07/24/2006] [Accepted: 08/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To characterize MR imaging features of pure mucinous carcinoma of the breast. MATERIALS AND METHODS MR images obtained from 16 women (age range, 29-81; mean age, 57 years) with pure mucinous carcinoma of the breast determined at surgery were reviewed. The MR findings used were shape, margin, internal mass enhancement, kinetic curve pattern on dynamic study, signal intensity on short time inversion recovery (STIR) T2-weighted images, and non-mass-like enhancement around the main tumor. Non-mass-like enhancement was compared with the presence of extensive intraductal component (EIC) on histopathological findings. RESULTS Eleven tumors (69%) had lobular contour, and nine tumors (56%) had smooth margin. Eight tumors (50%) showed rim enhancement and six tumors (38%) showed heterogeneous enhancement. Fourteen tumors (88%) showed a persistent enhancing pattern on kinetic curve. Fifteen tumors exhibited homogenous strongly high signal intensity on STIR T2-weighted images. In six cases with EIC, five cases had non-mass-like enhancement around the main mass. CONCLUSIONS MR findings such as lobular shape, rim or heterogeneous enhancement, persistent pattern on kinetic curve, and homogeneous strongly high signal intensity on STIR T2-weighted images may be useful in diagnosing pure mucinous carcinoma. Moreover, linear-ductal enhancement around main mass may indicate presence of EIC.
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Affiliation(s)
- Takashi Okafuji
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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38
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Bucciarelli E, Sidoni A, Bellezza G, Cavaliere A, Brachelente G, Costa G, Chaplet M, Castronovo V, Bellahcène A. Low dentin matrix protein 1 expression correlates with skeletal metastases development in breast cancer patients and enhances cell migratory capacity in vitro. Breast Cancer Res Treat 2006; 105:95-104. [PMID: 17136477 DOI: 10.1007/s10549-006-9436-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 10/20/2006] [Indexed: 10/23/2022]
Abstract
Small integrin-binding ligand N-linked glycoproteins (SIBLINGs) constitute a family of extracellular matrix proteins involved in bone homeostasis. Their pattern of expression has been primarily reported in bone and tooth and, more recently, in several cancer types. Dentin matrix protein 1 (DMP1), a SIBLING family member, expression was investigated by immunohistochemistry in a retrospective series of 148 primary human breast cancers. Correlations between DMP1 expression levels in the tumors and clinicopathologic features, bone metastases development and relapse of the disease were examined. DMP1 was expressed by 63.5% of the breast tumors analyzed. Significant inverse associations were found between DMP1 expression levels and the size and grade of the tumors (both, P < 0.0001). High DMP1 expression levels in the primary breast lesions were associated with a lower risk of subsequent development of skeletal metastases (P = 0.009). Patients with tumors expressing high levels of DMP1 had a significantly higher disease-free survival rate than those with low DMP1-expressing tumors (P = 0.0062). When DMP1 expression was examined in breast cancer cell lines, we found that non invasive MCF-7 and T47-D cells expressed higher levels than highly invasive MDA-MB-231 and Hs578T cells. Moreover, the specific inhibition of DMP1 expression in MCF-7 cells using siRNAs promoted significantly their migratory capability. Our data implicate for the first time DMP1 expression in breast cancer progression and bone metastases development.
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Affiliation(s)
- E Bucciarelli
- Institute of Pathologic Anatomy and Histology, Perugia University, Policlinico Monteluce, Perugia, Italy
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Lorente Ramos RM, del Valle Sanz Y, Alcaraz Mexía MJ, Jareño Dorrego E. [Medullary carcinoma of the breast: a malignant lesion mimicking a benign one]. RADIOLOGIA 2006; 48:165-8. [PMID: 17058639 DOI: 10.1016/s0033-8338(06)73147-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Medullary carcinoma of the breast is an unfrequent type of tumor. We present a case of medullary carcinoma of the breast. The patient presented with a palpable breast mass, corresponding on mammography to an obscured mass, which showed a cystic appearance with thick wall on sonography. We review the radiological findings of this type of tumor which should be considered in the differential diagnosis of lesions with well-circumscribed margins.
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Affiliation(s)
- R M Lorente Ramos
- Servicio de Radiodiagnóstico, Hospital Universitario Santa Cristina, Madrid, España.
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40
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Cheng SP, Chang YC, Liu TP, Lee JJ, Tzen CY, Liu CL. Phyllodes Tumor of the Breast: The Challenge Persists. World J Surg 2006; 30:1414-21. [PMID: 16865317 DOI: 10.1007/s00268-005-0786-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Phyllodes tumors of the breast are uncommon, and it is difficult to predict biologic behavior based on clinicopathologic features. Despite the wealth of data on the factors to predict recurrence, little is known about the impact of treatment refinements. This study seeks to define changes in patient characteristics, histopathologic parameters, and outcome between the two periods before and after the care of patients with breast diseases was centralized to a breast specialty. METHODS The records of 182 patients with phyllodes tumors managed surgically were reviewed. Patients treated from 1985 to 1996 (n=81) were compared with those seen from 1997 to 2004 (n=101). RESULTS The analysis of the two treatment periods revealed that there was a decrease in tumor size at diagnosis, from 7.7 cm during the earlier period to 4.6 cm during the recent period (P=0.003). The patients undergoing breast-conserving surgery were significantly increased during the recent period. In contrast, pathologic features and local recurrence rates remained unchanged during the study period. Multivariate analysis revealed that positive surgical margin was the only independent predictor of recurrence, with an increased hazard of 8.0. Overall, upgrading to the next grade was observed in 16% of recurrences. CONCLUSIONS Breast-conserving surgery with clear margins is the current treatment of choice for phyllodes tumors, but this strategy does not further reduce local recurrence effectively. Optimal management continues to be a challenge.
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Affiliation(s)
- Shih-Ping Cheng
- Department of Surgery, Mackay Memorial Hospital, 92, Sec 2, Chung-Shan North Road, and Mackay Medicine, Nursing, and Management College, Taipei, 10449, Taiwan
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Choi WWL, Lewis MM, Lawson D, Yin-Goen Q, Birdsong GG, Cotsonis GA, Cohen C, Young AN. Angiogenic and lymphangiogenic microvessel density in breast carcinoma: correlation with clinicopathologic parameters and VEGF-family gene expression. Mod Pathol 2005; 18:143-52. [PMID: 15297858 DOI: 10.1038/modpathol.3800253] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Angiogenesis and lymphangiogenesis are essential for breast cancer progression and are regulated by vascular endothelial growth factors (VEGF). To determine clinical and molecular correlates of these processes, we measured blood and lymphatic vascular microvessel density in 29 invasive carcinomas (22 ductal, six lobular, one papillary), using the vascular marker CD31 and the novel lymphatic marker D2-40. Microvessel density was assessed microscopically and by image cytometry, and was compared with tumor histology, grade, stage, lymph node metastasis, hormone receptors, HER2/neu status, and expression of VEGF, VEGF-C and VEGF-D by immunohistochemistry or quantitative RT-PCR. Strong correlation was observed between visual and image cytometric microvessel density using D2-40 but not CD31 (P=0.016 and 0.1521, respectively). Image cytometric CD31 microvessel density correlated with tumor size, grade, stage and lymph node metastasis (P=0.0001, 0.0107, 0.0035 and 0.0395, respectively). D2-40 microvessel density correlated with tumor stage (P=0.0123 by image cytometry) and lymph node metastasis (P=0.0558 by microscopy). Immunohistochemical VEGF signal in peritumoral blood vessels correlated with image cytometric CD31 and D2-40 microvessel density (P=0.022 and 0.0012, respectively), consistent with the role of VEGF in blood and lymphatic vascular growth. Intratumoral VEGF-C and VEGF-D expression by quantitative RT-PCR correlated with D2-40 (P=0.0291 by image cytometry) but not with CD31 microvessel density, which could suggest a selective role of VEGF-C and VEGF-D in lymphangiogenesis. CD31 and D2-40 microvessel density correlated significantly with several prognostic factors, including lymph node metastasis. Thus, measurements of angiogenesis and lymphangiogenesis may have utility for breast cancer pathology, particularly for estimation of metastatic risk.
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Affiliation(s)
- William W L Choi
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30033, USA
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Borges JBR, Soriano PG, Barros ND, Souza AZD, Barros ACD, Cerri GG, Pinotti JA. Avaliação por Doppler colorido do carcinoma da mama: correlação com dados clínicos e histopatológicos. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000500004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a capacidade da ultra-sonografia com Doppler colorido em caracterizar a vascularização de carcinomas sólidos da mama e em correlacionar padrões de vascularização com o tamanho, estádio e grau histológico destes tumores. MATERIAIS E MÉTODOS: Sessenta e seis carcinomas da mama foram estudados com Doppler colorido. As características morfológicas e fluxométricas foram avaliadas antes da biópsia e correlações com aspectos clínicos, histopatólogicos e estadiamento tumoral foram avaliadas estatisticamente. RESULTADOS: Cinqüenta e dois tumores (79%) apresentaram vasos penetrantes, 63 (95%) mostraram vasos periféricos, 33 (50%) tinham vasos centrais e em dois tumores (3%) não foi observada vascularização. O número médio de vasos nos tumores foi de 11,9 ± 7,7 e na mama contralateral foi de 1,7 ± 2,5. Nenhuma associação foi evidenciada com as características histológicas. A distribuição dos vasos foi diferente em dois grupos de tumores. Não houve diferença na velocidade diastólica, na resistência e no índice de pulsatilidade dos tumores e da mama contralateral. A velocidade sistólica nos tumores foi de 11,74 ± 0,96 e na mama contralateral foi de 9,45 ± 0,55. O número de vasos aumentou com a progressão do estadiamento dos tumores. CONCLUSÃO: O padrão vascular dos carcinomas da mama identificado pelo Doppler colorido deve ser considerado com potencial característica importante na avaliação pré-operatória destes tumores, em conjunto com outros fatores prognósticos como o tamanho tumoral e o estádio da doença.
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Sidoni A, Bellezza G, Cavaliere A, Del Sordo R, Scheibel M, Bucciarelli E. Prognostic indexes in breast cancer: comparison of the Nottingham and Adelaide indexes. Breast 2004; 13:23-7. [PMID: 14759712 DOI: 10.1016/j.breast.2003.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The search for single independent prognostic factors in breast cancer has often produced conflicting results. Therefore, prognostic indexes have been compiled by combining several parameters. In this study we compare the Nottingham Prognostic Index (NPI), which is based on traditional prognostic factors (diameter of the neoplasm, lymph node status and histological grade) with the Adelaide Prognostic Index (API), which is based on the tumour diameter and two biological parameters: oestrogen receptors and cell kinetics. We considered 82 cases of breast cancer observed over the period 1987-1990 with a minimum follow-up of 60 months. The NPI gives a better definition of the prognostic profile for each patient. Our results indicate three prognostic groups (good, moderate, unfavourable), which differ with respect to disease-free survival (DFS; P=0.0024) and overall survival (OS; P=0.0033). In contrast, the API scores showed no significant correlation with OS or DFS. The use of prognostic indexes, especially when compiled using traditional parameters, is a useful aid to the clinician, since they can provide a reliable indication of how individual tumours will evolve.
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Affiliation(s)
- A Sidoni
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, University of Perugia, Policlinico Monteluce, POB 1454, Perugia 06122, Italy.
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Sidoni A, Cavaliere A, Bellezza G, Scheibel M, Bucciarelli E. Breast cancer in young women: clinicopathological features and biological specificity. Breast 2004; 12:247-50. [PMID: 14659308 DOI: 10.1016/s0960-9776(03)00095-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Literature data suggest that breast cancers occurring in young patients may be different from those arising in older women. In this study the clinicopathologic characteristics of 50 patients under 40 years of age were compared with those of patients aged over 60. Patients under 40 years old more frequently had a family history of breast cancer than did older patients (24% vs 17%) and had more often used oral contraceptives (29% vs 13%); on average they had experienced menarche 1 year earlier. For early onset breast carcinomas there was a higher frequency of grade 3 tumours (38% vs 17%) and oestrogen receptor negativity (46% vs 20%). In addition, in younger patients the carcinomas were mostly DNA aneuploid (78% vs 58%), with a higher proliferation rate (48% vs 26%) and more frequent c-erbB-2 overexpression (48% vs 26%) and p53 alteration (30% vs 8%). Our data demonstrate that breast cancers arising in young women have a significantly different biopathological profile from those in older patients, with a predominance of unfavourable prognostic parameters.
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Affiliation(s)
- A Sidoni
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, University of Perugia, Perugia, Italy.
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Oshida K, Miyauchi M, Yamamoto N, Takeuchi T, Suzuki M, Nagashima T, Miyazaki M. Phyllodes tumor arising in ectopic breast tissue of the axilla. Breast Cancer 2003; 10:82-4. [PMID: 12525768 DOI: 10.1007/bf02967630] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined a 31-year-old woman with a solid mass in her left axilla. Physical examination and ultrasonography confirmed a 2 cm well-defined mass. Fine needle aspiration biopsy suggested fibroadenoma of breast. Excisional biopsy revealed benign phyllodes tumor of the ectopic breast tissue. Phyllodes tumor in ectopic breast tissue is an extremely rare occurrence. Only nine cases have been reported, including tumors of the vulva, inguinal region and axilla. This is the second case in the axillary region.
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Affiliation(s)
- Keiko Oshida
- Department of General Surgery, Chiba University Graduate School of Medicine, Japan
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Lilja A, Smith G, Malmström P, Salford LG, Idvall I, Horstman V. Psychological profile in patients with Stages I and II breast cancer: associations of psychological profile with tumor biological prognosticators. Psychol Rep 2003; 92:1187-98. [PMID: 12931938 DOI: 10.2466/pr0.2003.92.3c.1187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have earlier shown that breast cancer patients with moderately or well differentiated tumors seem to be able to inhibit stress evoked from anger in a successful manner, while those with poorer prognosis do not. We now report a study with an enlarged group of patients, investigating associations between tumor biological factors and psychological profile. 129 patients with Stages I and II breast cancer undergoing adjuvant radiation therapy were interviewed and tested with three projective personality tests assessing attitude to aggression and coping with stress and anxiety. Creative functioning was also tested. Patients with Stage I (smaller) tumors reported a "fighting spirit" attitude toward the disease, but they also showed depressive reaction patterns. Moreover, if the patient could successfully avoid or inhibit the stress evoked from perceiving an aggressive motif in the picture shown in the aggression test, the tumor biological situation was better. Patients who did not inhibit stress reactions on the aggression test and also on the anxiety test had a poorer tumor biological situation. Surprisingly, low speed of tumor cell proliferation (DNA S-phase fraction) correlated with high scores on the creativity test. Successful denial or inhibition of stress evoked by aggression combined with a creative, flexible attitude was associated with a better tumor biological situation.
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Affiliation(s)
- Asa Lilja
- Department of Clinical Neuroscience, Division of Neurosurgery, Lund University Hospital, Sweden.
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Bos R, van der Groep P, Greijer AE, Shvarts A, Meijer S, Pinedo HM, Semenza GL, van Diest PJ, van der Wall E. Levels of hypoxia-inducible factor-1alpha independently predict prognosis in patients with lymph node negative breast carcinoma. Cancer 2003; 97:1573-81. [PMID: 12627523 DOI: 10.1002/cncr.11246] [Citation(s) in RCA: 385] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hypoxia-inducible factor-1 (HIF-1) is a transcription factor that plays an important role in tumor growth and metastasis by regulating energy metabolism and inducing angiogenesis to survive cellular hypoxia. Increased levels of HIF-1alpha, the O(2)-regulated subunit of HIF-1, were noted during breast carcinogenesis. In this study, the prognostic value of HIF-1alpha expression and its correlation with various clinicopathologic variables in patients with invasive breast carcinoma were investigated. METHODS Expression levels of HIF-1alpha, HER-2/neu, estrogen receptor, and progesterone receptor were analyzed in 150 patients with early-stage breast carcinoma by immunohistochemistry. HER-2/neu gene amplification was investigated with automated fluorescent in situ hybridization. The mitotic activity index, histologic grade, and tumor type were assessed in hematoxylin and eosinstained specimens. Clinical data included disease-free survival, overall survival, lymph node status, and tumor size. The data were analyzed with two-sided univariate and multivariate tests, with P values < 0.05 considered significant. RESULTS High levels of HIF-1alpha had an association of borderline significance with decreased overall survival (P = 0.059) and disease-free survival (P = 0.110) that was ascribed completely to the subgroup of women with lymph node negative tumors (n = 81 patients; P = 0.008 and P = 0.004, respectively). HER-2/neu immunoreactivity (P < 0.001) and gene amplification (P < 0.001), vascular endothelial growth factor expression (P = 0.016), and Ki-67 expression (P < 0.001) were correlated strongly with HIF-1alpha positivity, although none of those factors had an independent effect on survival. CONCLUSIONS Increased levels of HIF-1alpha were associated independently with shortened survival in patients with lymph node negative breast carcinoma. Therefore, the use of immunohistochemical assessment of HIF-1alpha as a new predictor of poor outcome may improve clinical decision-making regarding adjuvant treatment of patients with lymph node negative breast carcinoma.
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Affiliation(s)
- Reinhard Bos
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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LILJA ASA. PSYCHOLOGICAL PROFILE IN PATIENTS WITH STAGES I AND II BREAST CANCER: ASSOCIATIONS OF PSYCHOLOGICAL PROFILE WITH TUMOR BIOLOGICAL PROGNOSTICATORS. Psychol Rep 2003. [DOI: 10.2466/pr0.92.3.1187-1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ng WK. Fine-needle aspiration cytology findings of an uncommon micropapillary variant of pure mucinous carcinoma of the breast: review of patients over an 8-year period. Cancer 2002; 96:280-8. [PMID: 12378595 DOI: 10.1002/cncr.10747] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous attempts at subclassifying pure mucinous carcinomas of the breast based on architectural patterns and other associated features are on record. A distinctive micropapillary variant with most tumor cells arranged in micropapillae/pseudoacini has not been described previously. METHODS The author reviewed the histologic slides from all 556 patients who underwent wide excision/mastectomy for mammary ductal carcinoma, either in situ or invasive, at Pamela Youde Nethersole Eastern Hospital, Hong Kong, during an 8-year period from early 1994 to the end of 2001. Five patients with pure mucinous carcinoma with diffuse micropapillary architecture were noted. The cytologic features (if available) were correlated with clinical, radiologic, and pathologic findings. RESULTS Among the five patients with pure mammary mucinous carcinoma (micropapillary variant), three patients underwent preoperative fine-needle aspiration biopsies and had specimens available for review. The direct smears and cytospin preparations were of moderate cellularity and showed cohesive clusters and micropapillae of mildly pleomorphic tumor cells among a mucoid background. True tumor papillae with fibrovascular cores were not present. Nuclear hobnailing was observed commonly, and occasional psammoma bodies were found. There were also scanty isolated tumor cells scattered around. The pseudoacinar pattern was appreciated more readily in the cell block sections. Histologic examination of the surgical specimens showed features of pure mucinous carcinoma with diffuse micropapillary architecture. The micropapillary arrangement was confirmed further by the demonstration of a reverse polarity immunostaining pattern for epithelial membrane antigen and the identification of microvilli rimming the periphery of tumor cell clusters under the electron microscope. Peritumoral lymphovascular permeation and ipsilateral axillary lymph node metastasis was found in one of the patients. CONCLUSIONS The micropapillary variant of mammary mucinous carcinoma demonstrates characteristic cytologic and histologic features that warrant special attention. It may represent the mucinous counterpart of invasive micropapillary carcinoma. Further analysis of a larger series of patients, however, will be required to delineate its prognostic significance, especially its propensity for lymph node metastasis.
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Affiliation(s)
- Wai-Kuen Ng
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
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50
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Lu D, Masood S, Khalbuss WE, Bui M. A subset of breast invasive ductal carcinoma with distinctive cytomorphology, aggressive clinical behavior, and unique immunologic profiles. Cancer 2002; 96:294-300. [PMID: 12378597 DOI: 10.1002/cncr.10745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Invasive ductal carcinoma of the breast is a heterogeneous collection of divergent types of carcinomas. Some subtypes have been characterized by histologic observations. This study describes a distinctive subset recognized through cytomorphologic examination of breast carcinoma specimens obtained by fine-needle aspiration biopsies (FNAB). Identification of this subset is established further by analyses of its clinical and immunologic characteristics. METHODS One hundred patients underwent FNAB and were diagnosed with breast ductal carcinoma. These diagnoses were followed by surgical resections and histologic evaluation of tumors. Immunohistochemical analyses of estrogen receptor, progesterone receptor, Her2/neu, p53 protein, and Ki-67 were performed. Patient's age, race, and family history of breast carcinoma were obtained. The objective of the study is to identify a cytomorphologically distinctive, clinically relevant, subset of breast carcinomas. RESULTS A subset carcinoma was recognized by cytomorphologic examination of Pap-stained FNAB slides. This subset consisted of seven patients with a median age of 37 years. At the time of surgical resection, all patients had axillary lymph node metastases. Six of seven patients had distant metastases. Immunohistochemical studies revealed that all tumors are positive for p53 protein and negative for estrogen and progesterone receptors. CONCLUSION This study presented a unique subset of breast ductal carcinomas that involved young patients and had aggressive growth behavior. These tumors expressed p53 protein but not estrogen and progesterone receptors.
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Affiliation(s)
- Di Lu
- Department of Pathology, The University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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