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Val-Bernal JF, Hermana S, Hernanz F, Moreno G. Primary de novo malignant peripheral nerve sheath tumor of the breast mimicking mastitis. Report of a case and review of the literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:73-82. [PMID: 37128794 PMCID: PMC10257786 DOI: 10.47162/rjme.64.1.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 05/03/2023]
Abstract
Malignant peripheral nerve sheath tumor (MPNST) is a rare tumor representing <0.1% of malignant breast tumors. Here, we report a case of sporadic MPNST of the breast in a 45-year-old woman with a fast-evolving painful mass in the right breast associated with edema, redness, and increased local temperature, simulating mastitis. This presentation has not been reported. A review of the literature since 1992 has revealed 15 MPNST cases, including the present one with sufficient data for analysis. All the cases were women. The ages ranged from 16-60 years (mean 40.5 years). Duration of symptoms varied from four days to 15 years (mean 2.7 years). Tumor size ranged from 2.5-30 cm (mean 10.9 cm). 64.3% of tumors were well-circumscribed. Tumors were graded as grade 1 (7.7%), grade 2 (38.5%), and grade 3 (53.8%). Three (20%) cases showed histopathological peculiarities. Simple mastectomy was performed in four (26.7%) cases, radical mastectomy in six (40%) cases, and simple excision in five (33.3%) cases. There were no metastases in the six cases where axillary dissection was performed. Seven (53.8%) patients received adjuvant therapy, including chemotherapy and∕or radiotherapy. Local recurrence was observed in two (16.7%) patients. Distant metastasis was detected in one patient (7.7%) affecting the lung 11 months after radical mastectomy. The follow-up was available for 10 patients (mean 2.2 years, median 1 year). One patient (10%) died of the disease. At the last follow-up, 80% of patients were still alive. The main differential diagnosis includes nonpleomorphic spindle cell tumors.
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Affiliation(s)
- José Fernando Val-Bernal
- Pathology Unit, Department of Medical and Surgical Sciences, University of Cantabria, Santander, Spain;
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Nagabushan S, Lau LMS, Barahona P, Wong M, Sherstyuk A, Marshall GM, Tyrrell V, Wegner EA, Ekert PG, Cowley MJ, Mayoh C, Trahair TN, Crowe P, Anazodo A, Ziegler DS. Efficacy of MEK inhibition in a recurrent malignant peripheral nerve sheath tumor. NPJ Precis Oncol 2021; 5:9. [PMID: 33580196 PMCID: PMC7881142 DOI: 10.1038/s41698-021-00145-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/06/2021] [Indexed: 01/30/2023] Open
Abstract
The prognosis of recurrent malignant peripheral nerve sheath tumors (MPNST) is dismal, with surgical resection being the only definitive salvage therapy. Treatment with chemoradiation approaches has not significantly improved patient outcomes. Similarly, trials of therapies targeting MPNST genomic drivers have thus far been unsuccessful. Improved understanding of the molecular pathogenesis of MPNST indicates frequent activation of the mitogen-activated protein kinase (MAPK) cell signaling pathway. MEK inhibitors have shown activity in preclinical studies; however, their clinical efficacy has not been reported to date. We describe here a case of sustained complete response to MEK inhibition in an adolescent patient with a recurrent metastatic MPNST with multiple alterations in the MAPK pathway, guided by a precision oncology approach.
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Affiliation(s)
- Sumanth Nagabushan
- grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia
| | - Loretta M. S. Lau
- grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Paulette Barahona
- grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Marie Wong
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Alexandra Sherstyuk
- grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Glenn M. Marshall
- grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Vanessa Tyrrell
- grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Eva A. Wegner
- grid.415193.bDepartment of Nuclear Medicine and PET, Sydney Children’s Hospital and Prince of Wales Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW Australia
| | - Paul G. Ekert
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Mark J. Cowley
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Chelsea Mayoh
- grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Toby N. Trahair
- grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
| | - Philip Crowe
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW Australia ,grid.415193.bNelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432Sydney Sarcoma Unit, UNSW Sydney, Sydney, NSW Australia
| | - Antoinette Anazodo
- grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.415193.bNelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW Australia
| | - David S. Ziegler
- grid.414009.80000 0001 1282 788XKids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW Australia ,grid.1005.40000 0004 4902 0432School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Children’s Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW Australia
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De Luca A, Frusone F, Vergine M, Cocchiara R, La Torre G, Ballesio L, Monti M, Amabile MI. Breast Cancer and Multiple Primary Malignant Tumors: Case Report and Review of the Literature. In Vivo 2019; 33:1313-1324. [PMID: 31280224 DOI: 10.21873/invivo.11605] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022]
Abstract
Multiple primary malignant neoplasms are multiple tumors with different pathogenetic origin. They may be synchronous or metachronous. The management of these conditions represents an interesting clinical scenario. A crucial aspect is the decision regarding which tumor to treat initially, and how to schedule further treatments according to individual tumor risk. This process involves a multidisciplinary physician team to ensure favorable outcomes. We describe a case report of a female patient affected by primary synchronous tumors of the breast and pectoral skin, which raised a series of diagnostic, etiological and therapeutic issues persuading us to carry out a critical review of the literature.
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Affiliation(s)
- Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Frusone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Vergine
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Rosario Cocchiara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Laura Ballesio
- Department of Radiology, Anatomo-Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Massimo Monti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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