Breast cancer (BC) is the most frequent cancer in European women with nearly 30% of the patients eventually developing metastases. Neuroendocrine differentiation is a rare event, but overexpression of somatostatin receptors in BC has been reported in many studies.
A patient with liver metastases from BC was treated with peptide receptor radionuclide therapy (PRRT). Computed tomography scan and biochemical examinations showed a clear response to radionuclide therapy.
PRRT may be useful in metastatic BC patients.
Radionuclide therapy; Peptide receptors
For patients with anthracycline-resistant metastatic angiosarcoma, there is currently no available standard for second-line therapy, and a need exists for novel effective regimens to improve response rates.
We report here on a case of a primary angiosarcoma of both breasts in a 34-year-old woman presenting with lung metastases. Upon completion of 3 cycles of the MAID regimen (mesna, adriamycin, ifosfamide, dacarbazine), computed tomography showed disease progression. Subsequently, a second-line chemotherapy was started using the GVP regimen (gemcitabine, vincristine, cisplatin). Complete response of the lung metastases was achieved after 6 cycles of treatment.
In the absence of an effective therapy among patients with anthracycline-resistant metastatic breast angiosarcoma, a GVP chemotherapy regimen can be performed as a selective option.
Breast neoplasm; Angiosarcoma; Lung metastases; Gemcitabine; Vincristine; Cisplatin; Chemotherapy
Breast tuberculosis is an uncommon disease even in countries where the incidence of tuberculosis is high.
This is a case series concerning 4 postmenopausal breast tuberculosis cases encountered in Moulay Youssef Hospital between January 2007 and December 2010. Breast tuberculosis represents 0.25% of all hospitalized tuberculosis patients in our department. The mean age of our patients was 62.5 ± 5.8 years. Clinical findings were heterogeneous; 1 case was multifocal tuberculosis, and another case was coexistent tuberculosis and malignancy of the breast. Mammography and ultrasonography findings were suspicious for malignancy in all 4 cases. Fine needle aspiration was negative in 3 cases. The diagnosis was made in all patients by histological examination of biopsy specimens, which revealed typical tuberculous lesions. Anti-tuberculosis therapy formed the mainstay of treatment.
The clinical and radiological features of mammary tuberculosis can be very confusing and easily mistaken for breast cancer. Symptoms suggestive of tuberculosis warrant a biopsy to exclude possible cancer.
Breast; Lump; Tuberculosis; Menopause
Breast cancer is the most common cancer diagnosed during pregnancy.
We report on a case of a 26-year-old woman who was diagnosed with right-sided breast cancer in her 15th week of gestation. We discussed possible treatment scenarios and the patient opted for neoadjuvant therapy with taxanes and anthracyclines during pregnancy, followed by delivery and then followed by surgery, antibody therapy, and radiotherapy. The patient received neoadjuvant chemotherapy with paclitaxel 80 mg/m2 weekly for 12 cycles, followed by 4 cycles of epirubicin and cyclophosphamide (90/600 mg/m2) every 3 weeks. Complete clinical response was seen after preoperative chemotherapy. After delivery of a healthy child at 40 weeks of gestation, she received breast-conserving surgery and axillary dissection. Anti-HER2 antibody treatment with trastuzumab was started concomitantly with adjuvant radiotherapy. Endocrine treatment with a gonadotropin-releasing hormone (GnRH) analog and tamoxifen for 5 years was planned to be started after radiotherapy.
Treatment of breast cancer during pregnancy requires an interdisciplinary approach and careful consideration of the patient's stage of disease, the gestational age, and the preferences of the patient and her family.
Pregnancy-associated breast cancer; Outcome of pregnancy; Neoadjuvant chemotherapy; Interdisciplinary care
Glycogen-rich clear cell carcinoma of the breast is a rare histological subtype of breast cancer, accounting for 0.9–2.8% of all breast cancer cases. Fewer than 100 cases have been reported in the literature. Most of these tumors are invasive carcinomas. The intraductal glycogen-rich clear cell carcinoma is a very rare occurrence.
Herein is described a case of a pure intraductal glycogen-rich clear cell carcinoma of the breast in a 42-year-old premenopausal woman. A literature review has also been carried out. Mammography was inconclusive due to the presence of dense breast tissue, but magnetic resonance imaging (MRI) showed several nodular lesions measuring 7 × 6 cm in diameter and involving the upper aspect of the right breast suggestive of multifocal malignancy. A modified radical mastectomy was performed. The patient started hormonal therapy with tamoxifen and is currently well 16 months after surgery.
A pure intraductal glycogen-rich clear cell carcinoma of the breast is a very rare occurrence. The case presented here exhibited uncommon MRI features, whereas the tumor size is one of the largest reported in the literature. Mammography may be inconclusive in the presence of dense breast tissue, but MRI is of great importance in the preoperative evaluation of the patient.
Clear cell breast carcinoma: glycogen-rich, intraductal
Male breast cancer is rare and represents less than 1% of all breast cancers. Considering the fact that the male breast most often does not consist of lobules and acini, lobular carcinoma of the male breast is exceptionally rare.
In this paper we present a unique case of alveolar variant of lobular male breast cancer in a 56-year-old patient.
According to our knowledge this is the first presentation of an alveolar variant of lobular male breast cancer that appeared 14 years after chemo- and radiotherapy for the treatment of Hodgkin's disease.
Male breast cancer; Histology; Immunohistochemistry; Pathology
In the routine work-up of suspect breast lesions, ultrasound-controlled core needle biopsy (CNB) is the most common tool to acquire tissue for histopathologic analysis in a safe, quick and convenient way. Complications are generally rare. The most common complications are hematoma and infection, each with less than 1 in 1000 cases.
Here, we present a case of a 48-year-old patient who underwent CNB for several lesions that were assessed as Breast Imaging Report and Data System (BI-RADS) IV in breast ultrasound and mammography. In the past, she had had 2 bilateral breast reduction surgeries and 1 open biopsy of a fibroadenoma. Histology revealed a phyllodes tumor. Following this, mastitis occurred which was resistant to common conservative measurements such as intravenous antibiotics over months. Finally, mastectomy was performed, followed by adequate wound healing.
In the presented case, the prolonged course of breast infection after CNB was not as expected. If this occurs, conservative treatment with antibiotics can be initiated. Possible additional risk factors such as diabetes mellitus, steroid therapy, or immunosuppression should be identified. However, in case of missing recovery, wide surgical excision is recommended.
Core needle biopsy; Complication; Mastitis; Phyllodes tumor
MRI has been demonstrated to be the most sensitive imaging method for detecting breast cancer in women at high risk, allowing depiction of cancers that are occult on mammography, ultrasound and clinical breast examination. This high sensitivity is tempered by imperfect specificity due to overlap in the features of benign and malignant lesions.
We present the case of a young BRCA2 mutation carrier whose breast cancer could have been diagnosed 2 years earlier; this is a rare case of a false-negative finding in MRI.
We discuss morphological, physiological and psychological reasons for underestimation of MRI sets, especially in young women.
We conclude that double reading in MR screening for breast cancer in high-risk women, as conducted for mammography screening, could be considered.
Breast imaging; Familiar breast cancer; Double reading
This article is concerned with the evaluation of an adolescent breast mass using imaging methods.
A 14-year-old girl presented with progressive asymmetric enlargement of the left breast. She had felt a breast lump about 4 months earlier, and over the last 2 months it had been growing progressively. Tumor markers, including AFP, CEA, CA15-3, and CA125, were all normal. Ultrasonography showed a hypoechoichyperechoic, solid mass. Magnetic resonance imaging of the breast revealed a well marginated mass with hypointensity on T1-weighted images and mild hyperintensity on T2-weighted images, which showed mild contrast uptake. Biopsy revealed an undifferentiated malignant mesenchymal sarcoma. The patient underwent mastectomy with axillary lymph node sampling. After the operation, she received 3 cycles of chemotherapy and radiotherapy.
Due to the rarity of breast sarcoma and inadequate imaging methods to establish an exact diagnosis, radiologists and clinicians may misdiagnose and merely follow these tumors. As in our case, the histology of the patient may be the leading factor in the management of these tumors. Even in very young patients, progressively growing breast masses should alert the clinician to check for malignancy verified by biopsy.
Breast lump; Sarcoma, undifferentiated; MRI; Adolescent breast cancer
Carcinosarcoma is an exceptionally rare and poorly differentiated kind of breast neoplasm with only few published reports in the literature.
We report a case of breast carcinosarcoma in a 26-year-old Chinese female patient, presenting as multiple lumps in a single breast. A nipple-sparing modified radical mastectomy was performed. The patient is now in her 7th postoperative month and disease-free.
Carcinosarcoma is challenging to diagnose preoperatively, even with core needle biopsy histopathology. Modified radical mastectomy is an efficient and practical operative treatment. Application of adjuvant therapy should be based on the proportion of carcinomatous component of the lesion in pathological test. Careful periodic follow-up after the initial treatment is strongly recommended.
Reproductive tract sarcomas metastasizing to the breast are uncommon. To our knowledge, metastasis of vaginal leiomyosarcoma to the breast has not been previously reported in the literature.
We present the first report of a FIGO stage IV primary vaginal leiomyosarcoma with metastases to the lung and left breast. Treatment included neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. Lung metastasis disappeared but recurred 14 months later in conjunction with left breast metastasis which was resected.
Primary vaginal sarcoma with lung and breast metastases is very rare in female genital malignancies. We present this case to alert gynecologists to the need for early diagnosis and aggressive management.
Vaginal leiomyosarcoma; Breast metastasis; Lung metastasis; Neoadjuvant chemotherapy
Parotid gland metastasis in breast cancer is extremely rare, and only 14 cases have been reported between 1982 and 2010.
A 67-year-old female patient was diagnosed with invasive lobular carcinoma of the left breast. Although clinical staging was T1N3M1 (stage IV), the tumor experienced a complete response to chemotherapy. We therefore performed a mastectomy followed by radiotherapy, and continued administration of trastuzumab. However, 11 months later, the patient complained of a swelling in the left parotid gland. Histology following a partial parotidectomy revealed a parotid gland metastasis from the breast.
Treatment with capecitabine in addition to trastuzumab, which is one of the strategies applied in HER2-positive breast cancer, was effective in our patient. Analysis of the 14 cases of parotid gland metastasis from the breast reported between 1982 and 2010 revealed that the metastasis may occur not by direct lymphatic but by hematogenous spread.
Parotid gland metastasis; Breast cancer; Trastuzumab
Poland's syndrome is a rare congenital non-inherited anomaly that usually manifests itself during adolescence and is characterized by absence or deficient development of one of the breasts. To our knowledge, no case of breastfeeding after reconstruction surgery in patients with Poland's syndrome has been described.
A 22-year-old female patient with Poland's syndrome underwent breast reconstruction. The procedure performed consisted of rotation of a myocutaneous flap harvested from the ipsilateral latissimus dorsi muscle, which was subsequently attached to the anterior thoracic wall to create a pouch and place a 300-ml round textured cohesive silicone gel-filled breast implant. 5 years later the patient got pregnant, and 1 year after delivery she is still breastfeeding normally with both breasts.
Reconstruction surgery with the latissimus dorsi muscle and a prosthesis was shown to be a potential and safe solution to achieve improvement of breast symmetry and to provide confidence and comfort in relation to self-image and, moreover, the ability to breastfeed.
Poland's syndrome; Mammoplasty; Prostheses; Implants; Breastfeeding
Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin®) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.
Fetus; Renal insufficiency; Trastuzumab; Breast cancer; Pregnancy
Primary lymphoma of the breast accounts for 0.04–0.5% of all breast malignancies and approximately 1% of all extranodal lymphomas. For stage IE node-negative disease, involved field radiotherapy is recommended except for very young women in whom the risk of breast cancer is a concern. The rate of complete response for limited stage extranodal marginal B-cell lymphoma is in excess of 90%.
We report the case of a 62-year-old lady who presented with a unilateral painless palpable right breast lump. She subsequently underwent a trucut biopsy of the lesion. The histology revealed a low-grade B-cell non-Hodgkin's lymphoma (NHL). Immunohistochemistry showed that more than 95% of the cells were B cells which were CD 20+/CD 45+ and BC L6+. This confirmed the diagnosis of marginal zone lymphoma. Staging work-up was negative for distant metastases. Serum alkaline phosphatase and lactate dehydrogenase were normal. The patient had no ‘B’ symptoms. Her final diagnosis was clinical stage IAE NHL, and she was referred for curative radiotherapy.
Radiation treatment is a safe and extremely effective modality of treatment for early stage I marginal zone B-cell lymphomas of the breast.
Marginal zone B-cell lymphoma; Breast; Non-Hodgkin's lymphoma; Involved field radiotherapy
In vitro and in vivo analyses have shown differences in chemosensitivity between breast cancers associated with BRCA1/2 mutations compared to sporadic variants. In the preoperative setting, the tumor response can be directly measured. Therefore, preoperative systemic treatment (PST) offers the opportunity to assess the chemosensitivity in vivo. However, there have been neither clear guidelines for mutation carriers in terms of choice of chemotherapy regimen nor recommendations how to proceed in case of an inadequate response to PST.
Herein, we present the history of a 39-year-old woman with bilateral breast cancer who was tested positive for germ-line BRCA1 mutation while under PST. We performed a comprehensive literature review covering the MEDLINE database from 1992 to 2010 on published data regarding PST options for BRCA mutation carriers.
If results of genetic testing are obtained during PST, individual therapy adaptations can be discussed with respect to mainly retrospective data of response to specific drugs. However, larger studies with longer follow-up are eagerly needed to draw firm conclusions before any specific treatment recommendations can be given for BRCA mutation carriers. PST is an ideal setting to evaluate such treatment options and to describe predictive markers that can help define subgroups that benefit most.
Preoperative chemotherapy; BRCA mutation; Breast cancer
Breast angiosarcoma is a rare disease occurring as primary tumour or secondary to lymphoedema or radiotherapy. The more frequent use of breast-conserving therapy and radiotherapy for breast carcinoma explains the increasing diagnosis of these tumours.
We report a case of a breast epithelioid angiosarcoma which metastasized to the contralateral axillary lymph node, occurring 4 years after breast-conserving therapy with axillary lymph node dissection and radiotherapy. The patient presented skin lesions and an axillary lump (clinically diagnosed as carcinoma relapse and lymph node metastasis). Fine-needle cytology on both lesions and a core needle biopsy of the axillary lump were carried out. Differential diagnosis included carcinoma, malignant melanoma, and angiosarcoma. Immunohistochemistry confirmed the diagnosis of angiosarcoma.
Breast angiosarcoma is a challenge – clinically, radiologically and pathologically – and requires a high index of suspicion in susceptible patients.
Breast-conserving surgery; Radiotherapy; Epithelioid angiosarcoma; Lymph node metastasis
Metaplastic carcinoma of the breast is a rare but distinct entity within the group of undifferentiated invasive carcinomas. This entity accounts for less than 0.5% of all breast cancers and contains elements of epithelial (ductal), mesenchymal, and intermediate forms of differentiation. Of these metaplastic carcinomas, there have been reports of chondroid, squamous, osseous, and spindle differentiation.
We describe the clinical course of a 52-year-old female patient with an unusual histopathology of a spindle cell carcinoma of the breast, discuss the literature, and recommend an approach to diagnosis and treatment. The patient initially presented to an outside hospital with a rapidly growing breast mass that was originally diagnosed as a malignant phylloides tumor. She presented 11 months after the primary treatment with a local subcutaneous relapse. She later developed a local relapse of her metaplastic carcinoma in the chest wall. Extensive histopathological analysis lead to the diagnosis of a spindle cell metaplastic breast carcinoma with leiomyoid differentiation, which has not been described previously.
Overlap in morphology can lead to a misinterpretation or underdiagnosis of metaplastic carcinomas. However, the prognosis is similar to more common types of breast adenocarcinoma.
Carcinoma; Leiomyoid; Metaplasia; Phylloides; Spindle Cell
An 82-year-old patient underwent a mastectomy and axillary lymph node clearance for a large multicentric lobular cancer of the left breast. On day 11 after her operation, white viscous fluid was noted in her axillary drain.
We analysed case reports in the literature, noting the interval between surgery and diagnosis of chyle, the duration of the chyle leak, the volume of chyle during the first 24 h, the median volume and the administered treatment.
25 cases were reported in 13 publications. Our case was unusual in that chyle was noted 11 days after surgery. In most cases, chyle leakage subsides spontaneously by simply leaving the drain in situ.
A conservative observant approach appears appropriate in most cases. Only for persistent and large-volume leaks, dietary intervention (medium-chain lipid diet, nil by mouth, total parenteral nutrition) is justified. Surgery with re-exploration of the axilla and oversewing of the chyle duct can be used as the last reserve for persistent chyle leaks.
Breast cancer; Complication; Lymph node dissection; Parenteral nutrition; Breast neoplasm; Axillary clearance
Metastases to the parotid and thyroid glands from breast cancer are rare and have a poor prognosis.
We present the case of a patient with breast carcinoma and synchronous involvement of both the parotid and thyroid gland, and review the literature on this subject.
Metastatic malignancy in clinically suspect thyroid and parotid nodules could be detected more frequently with routine use of fine needle aspiration biopsy.
Breast neoplasm; Metastasis; Parotid; Thyroid; Synchronous neoplasms
We report the case of a 74-year-old female patient who presented at the Breast Care Centre with watery discharge from a fistula in the inframammary fold of the left breast.
The patient initially presented with watery discharge coming from the fistula, which later took on a more viscous consistency. She reported mild discomfort as well as mild erythema. Clinical examination and diagnostic approaches including magnetic resonance imaging (MRI) revealed a cutaneous silicone fistula as a rare complication following breast implant reconstruction. The condition was treated with excision of the fistula and bilateral implant removal.
This case report documents a rare complication following breast reconstruction with implants, and is to our knowledge the first described MRI-detected cutaneous silicone fistula.
Cutaneous silicone fistula; Capsular contracture; Silicone breast implant; MRI
Fibroadenomas are common neoplasms in young women but occur in a wide age range from adolescent females to octogenians.
A 21-year-old female patient presented with a 10-week history of a mass in her breast. Ultrasound examination demonstrated a 3.5 × 3 cm, well-circumscribed, semisolid mass. An excisional biopsy but no fine needle aspiration was performed. The patient had no history of pregnancy or lactation, or trauma or infection to the area of the lesion. The histopathological examination showed a spontaneously infarcted fibroadenoma.
Spontaneous infarction is an uncommon complication in fibroadenoma of the breast, and there are very few reported cases in the literature.
Fibroadenoma; Infarction; Breast
Patients presenting with symptoms from unknown metastatic breast carcinoma are becoming increasingly uncommon. Perforated appendicitis from metastatic breast carcinoma is a rare entity with only a few published reports in the literature.
The case of a 76-year-old female patient who developed perforated appendicitis from previously unknown metastatic breast cancer is presented. During physical examination in the emergency department, a large left breast mass was palpated. The patient underwent an appendectomy and had no gross evidence of disease elsewhere in the intra-peritoneal cavity. Subsequent pathologic examination of the appendix revealed a lobular carcinoma.
The factors that influence the site of metastasis from breast cancer include estrogen receptor status and the subtype of carcinoma – ductal versus lobular.
Breast cancer; metastasized; Appendicitis
Sentinel lymph node biopsy (SLNB) is a widely accepted method to determine lymph node status in for instance breast cancer, cervical cancer, or cutaneous melanomas. Although injection of blue dyes facilitates successful detection of sentinel nodes, they have also been shown to cause adverse reactions.
A 62-year-old female patient was referred to the surgical department of the Atrium Medical Centre with a suspicious lesion located in the right breast, detected during population-based screening. Immediately after injection of patent blue V, the patient developed tachycardia on top of preexisting supraventricular tachycardia and showed an instant drop in blood pressure, after which cardiac arrest occurred. These clear symptoms of anaphylactic shock required prompt treatment, and the patient was treated accordingly.
Anaphylactic shock after injection of patent blue V remains a serious adverse event and warrants awareness. Immediate action with ephedrine, antihistamines, and subsequently corticosteroids can stabilize the patient. Tc-99m, isosulphan blue, and methylene blue can alternatively be used for SLNB, although also not without side effects.
Sentinel node; Patent blue; Anaphylactic shock; Breast cancer
The stromal reaction may be one of the key factors in the development of breast carcinomas.
We report the case of an 80-year-old female patient who ignored a very slow growing, extensive scirrhous breast carcinoma for almost 20 years duration.
Histopathology analysis revealed a Scarff Bloom Richardson (SBR)3-grade, estrogen receptor (ER)-positive (80%), progesterone receptor (PR)-positive (10%), HER2/neu-negative, lobular-invasive, scirrhous breast carcinoma with large cells.
A strong peritumoral fibrous stromal reaction may explain the longstanding evolution of the tumor without any distant metastases.
Breast Cancer: scirrhous, Lobular