Breast Disease - Volume 41, issue 1

Authors: Salmanpour, Ali | Rezaeifard, Somayeh | Kiani, Razie | Tahmasebi, Sedigheh | Faghih, Zahra | Erfani, Nasrollah

Article Type: Research Article

Abstract: BACKGROUND: A recently introduced CD4+ T subset that mainly secretes interleukin (IL-) 22 has been reported to be associated with a variety of tumors, including colon, gastric, hepatocellular, and small- and large-cell lung carcinoma. Both tumor-promoting and - suppressing roles have been suggested for these cells. In the present study, we aimed to investigate the frequency of IL-22-producing subsets in tumor-draining lymph nodes (TDLNs) of the patients with breast cancer and determine their association with the clinicopathological characterizations of the disease. METHODS: Thirty untreated women diagnosed with breast cancer were enrolled and their axillary lymph nodes were …dissected during surgery. Mononuclear cells were isolated using Ficoll density gradient, activated, permeabilized, and stained by fluorochrome-conjugated antibodies against CD4, IL-22, IL-17, and IFNγ. The cells were then acquired on the FACSCalibur flow cytometer, and raw data was analyzed by the FlowJo software package (V10). RESULTS: Our results demonstrated that 2.39% ± 0.39 of CD4+ lymphocytes in TDLNs of patients with breast cancer produced IL-22. Among them, 0.64% ± 0.8 just produced IL-22 but were negative for IFNγ and IL-17. Statistical analysis indicated that the frequency of CD4+IL-22+ cells was significantly higher in the patients with stage III and the ones with 3–9 tumor involved lymph nodes (N2) compared to those with stage II and those having 1–3 tumor involved lymph nodes (N1) (P = 0.008 and P = 0.004, respectively). CONCLUSION: The higher frequency of IL-22-producing cells in draining lymph nodes of patients with more advanced tumors (higher stage (stage III) and more involved lymph nodes) suggests a role for IL-22-producing cells in the tumor progression and invasion. However, further studies with larger sample size and more functional studies are needed to clarify the role of IL-22-producing cells in breast cancer pathogenesis. Show more

Keywords: Breast cancer, lymph nodes, T helper 22, IL-22-producing cells

DOI: 10.3233/BD-210084

Citation: Breast Disease, vol. 41, no. 1, pp. 383-390, 2022

Authors: Jha, Chandan Kumar | Verma, Harshit | Sinha, Upasna | Singh, Prashant Kumar

Article Type: Case Report

Abstract: Increased utilization of chemotherapy in breast cancer patients has led to improved survival outcomes but it has also resulted in rising incidence of adverse effects. Occurrence of new/unreported side effect poses challenge in front of clinicians. We report the case of a 53-year lady with locally advanced, hormone receptor-positive, and human epidermal growth factor-2 (HER-2) negative right breast carcinoma. She was started on neoadjuvant chemotherapy (NACT) (doxorubicin and cyclophosphamide), to facilitate breast-conserving surgery. She developed an inflammatory reaction involving the affected breast after each of three cycles of NACT (2 cycles of doxorubicin & cyclophosphamide, and 1 cycle of docetaxel). …Infectious causes and disease progression were ruled out. She was then prescribed hormone therapy but the disease progressed after three months of therapy and the patient had to be subjected to modified radical mastectomy (MRM). She then received adjuvant radiotherapy and is currently doing well on second-line hormone therapy. Show more

Keywords: Inflammatory response, breast carcinoma, neoadjuvant chemotherapy for breast carcinoma, inflammatory response to anthracyclines, inflammatory response to docetaxel

DOI: 10.3233/BD-220007

Citation: Breast Disease, vol. 41, no. 1, pp. 391-395, 2022

Authors: Yepes, Monica M. | Feliciano, Yara | Net, Jose | Betancur, Veronica | Gomez-Fernandez, Carmen | Collado-Mesa, Fernando

Article Type: Case Report

Abstract: The presence of mammographically evident hyperdense foci within axillary lymph nodes elicits concern for calcium deposits, which in turn have a wide differential diagnosis including both benign and malignant entities. Tissue sampling, most commonly by way of image-guided core needle biopsy, is needed in many cases when a definite etiology cannot be clinically established. In this case series we present history, imaging findings, and pathology results (or long term follow-up stability as biopsy surrogate) of several women with body tattoos who at mammography were noted to have a characteristic pattern of “bubbly” pseudo-calcifications within axillary lymph nodes, and absence of …other mammographic, sonographic and clinical abnormalities. Show more

Keywords: Lymph node, tattoo pigment, pseudo-calcifications, hyper-densities, mammography, ultrasound

DOI: 10.3233/BD-220011

Citation: Breast Disease, vol. 41, no. 1, pp. 397-406, 2022

Authors: de Oliveira-Junior, Idam | Barbin, Flávia Fazzio | Watanabe, Anapaula Hidemi Uema | dos Reis, Ricardo | da Costa Vieira, René Aloisio

Article Type: Case Report

Abstract: INTRODUCTION: Metastatic disease to the breast is a rare condition, with contralateral breast metastasis being the most common primary site. CASE PRESENTATION: We present the case of a patient who underwent treatment for an HPV positive squamous cell carcinoma (SCC) of the cervix who, during follow-up, complained of a nodule in her left breast. Anatomopathological results indicating squamous carcinoma, which was not able to be differentiated from breast metaplastic carcinoma. Resection of the lesion was carried out, confirming carcinoma with squamous cell differentiation with negativity for GCDFP-15, mammaglobin, p63 and SOX10, but with positivity for p16 and for …high risk HPV, confirming a single metastatic lesion of cervical carcinoma. DISCUSSION/CONCLUSION: In the presence of SCC in the breast, the differential diagnosis may consider the presence of primary lesion, metaplastic carcinoma with squamous cell differentiation or metastatic disease. The use of markers such as p63, SOX10 and p16, may help for a definitive diagnosis. Show more

Keywords: Cervical cancer, breast metastasis, metastasis, HPV

DOI: 10.3233/BD-220027

Citation: Breast Disease, vol. 41, no. 1, pp. 407-411, 2022

Authors: Ramadan, Rabie | Koryem, Islam M. | Fayed, Haytham

Article Type: Research Article

Abstract: BACKGROUND: IGM has a diagnostic and treatment dilemma. The etiology of IGM is unknown but some conditions have been discussed as predisposing factors including Oral Contraceptive Pills, pregnancy, breast feeding, reproductive age, hyperprolactinemia, infectious and autoimmune diseases. The current study aimed to determine possible risk factors for IGM and to evaluate our experience in its management. PATIENTS AND METHODS: The study included forty patients with IGM and forty females with normal breasts as a control group. CST treatment was initiated for all patients; patients who responded completely were followed up without surgical intervention. Failure to respond to medical …therapy or incidence of corticosteroid-related complications were considered indications for surgical treatment. All patients were followed up for 6 months to detect recurrence. RESULTS: IGM had a significant higher incidence rate in young females within 5 years from the last lactation, smokers, those with hypperprolactinaemia, who had a history of breast feeding and those who received OCP (P = <0.001, <0.001, 0.006, 0.001, 0.023 and 0.027 respectively). The central part of the breast was more affected (9 cases (22.5%)). Multicenteric disease affected 8 cases (20%). Breast Mass was the most common presenting sign. After CST; the mass disappeared in 5 cases (12.5%), mass size reduced in 26 cases (65%) and mass size not affected in 9 cases (22.5%). Surgery was done in whom the mass size was reduced or not affected (35 cases (87.5%)). Disease recurrence was reported in 2 cases (5.7%). CONCLUSION: IGM usually affects females in their childbearing period with multiple risk factors mainly parity, smoking, OCP and breast feeding with wide variation regarding the presenting manifestations. We should start with CST as there is always a chance to avoid unnecessary surgery and combination of both modalities can reduce the incidence of recurrence. Show more

Keywords: Idiopathic granulomatous mastitis, corticosteroid therapy, Recurrent mastitis

DOI: 10.3233/BD-220047

Citation: Breast Disease, vol. 41, no. 1, pp. 413-420, 2022

Authors: Elnahas, Waleed | Metwally, Islam H. | Bonna, Khaled | Youssef, Marco | AbdAllah, Samar | Bonna, Mohamed | Ali Faried, Mohamed | Atef Tira, Mohamed | Hamdy, Omar

Article Type: Research Article

Abstract: BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS: This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS: …The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕− 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients’ age, marital status, and imaging criteria as measured by BIRADS score were significant (<0.001). CONCLUSION: Approaching patients with the age above 35 or with BIRADS 4 provisionally diagnosed with fibroadenomas should be cautious with biopsy and short-term follow-ups The size of the tumor alone should not be used as an indication for surgical intervention. Show more

Keywords: Breast lump, fibroepithelial tumor, breast cancer, phyllodes tumor

DOI: 10.3233/BD-210074

Citation: Breast Disease, vol. 41, no. 1, pp. 421-426, 2022

Authors: Kurniawan, Benny Nanda | Ferianto, Djonny | Pieter Jr, John

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer in Indonesia has continued to increase. One diagnostic modality is immunohistochemical examination to determine breast cancer subtypes. OBJECTIVE: To determine breast cancer metastasis and mortality rates based on molecular subtypes. METHODS: A descriptive study was conducted based on retrospective data from hospital medical records from January 2016 to December 2019. The data comprised age, clinical stage, histopathological grade, molecular subtype, location, metastasis, and breast cancer mortality. The data were processed and analyzed. RESULTS: This study involved 172 patients. The most prevalent breast cancer subtypes were luminal A (60, 34.8%), followed by …HER2 (47, 27.4%), triple-negative (38, 22.4%), and luminal B (27, 15.4%). The metastasis rate was 37.21% (64/172), with bone the tissue most affected (32 cases, 50%), followed by lung (24 cases, 37.5%) and liver (8 cases, 12.5%). The highest rates of bone, lung, and liver metastases were subtypes luminal A (31%), HER2 (29%), and triple-negative (38%), respectively. The mortality rate was 21% (36/172), with most in the triple-negative group (28.9%), followed by luminal B (25.9%), HER2 (21.2%), and luminal A (13.3%). CONCLUSIONS: Determination of breast cancer molecular subtypes through immunohistochemistry can determine the level of metastasis and mortality in breast cancer. Show more

Keywords: Breast cancer, metastasis, molecular subtype, mortality

DOI: 10.3233/BD-229000

Citation: Breast Disease, vol. 41, no. 1, pp. 427-432, 2022

Authors: Saputra, Teddy Agung | Indra, Indra | Syamsu, Salman Ardi | Sampepajung, Elridho | Nelwan, Berti Julian | Hamid, Firdaus | Faruk, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: Molecular marker analysis has become important in breast cancer diagnosis and treatment and may reveal new mechanisms in breast cancer pathogenesis. Aside from the commonly used hormonal receptors and HER2, VEGF-A has been increasingly shown to be important in breast cancer diagnosis and pathogenesis. OBJECTIVE: This study aimed to determine the relationship between VEGF-A expression on ER and PR and HER2 hormonal status in patients with late-stage breast cancer (locally advanced or with distant metastases). METHODS: This observational, cross-sectional study examined VEGF-A expression and molecule markers (ER, PR, and HER2) of breast cancer tissue using …immunohistochemistry. The Chi-square test was used to determine whether two categorical variables were correlated. Statistical significance was set at p < 0.05. RESULTS: VEGF-A showed no significant correlation with demographic characteristics, TNM staging, pathological grading, luminal or non-luminal type, or hormonal receptor markers but showed a significant positive correlation with HER2 receptors (p = 0.036). CONCLUSIONS: VEGF-A was positively correlated with HER2 expression in breast tumor tissue but showed no significant correlation with other breast cancer markers, including luminal typing or hormonal receptors. Further study is needed to understand the mechanistic interplay between VEGF and HER2 in breast cancer pathogenesis. Show more

Keywords: Breast cancer, locally advanced breast cancer, metastatic breast cancer

DOI: 10.3233/BD-229006

Citation: Breast Disease, vol. 41, no. 1, pp. 433-438, 2022

Authors: Marhaeni, Marhaeni | Rahmawati, Ros | Sonda, Maria | Noor, Hasnah M. | Prihantono, Prihantono

Article Type: Research Article

Abstract: INTRODUCTION: Breastfeeding is the first step to forming children who are not only healthier but smarter, with a better emotional quotient (EQ) and spiritual quotient (SQ). Babies need physical closeness and warmth from their mother as much as optimal nourishment. Poor knowledge and attitudes towards exclusive breastfeeding can result from information that is not intensive and maximal, due to limited breastfeeding counseling staff. Other reasons include cultural factors, especially in coastal areas, such as the belief in prelacteal feeding before the first breastfeeding; the baby has then automatically not exclusively breastfed. METHODS: This study used an intervention with …a one-group pretest–posttest design. It aimed to analyze the role of breastfeeding counseling in increasing mothers’ knowledge and attitudes regarding exclusive breastfeeding. The participants were pregnant women from the end of the second trimester to the third trimester, selected using stratified systematic random sampling. RESULTS: Counseling had a significant effect on mothers’ knowledge (p = 0.004) and attitude (p = 0.000) in changing the behavior of coastal communities towards giving exclusive breastfeeding (p = 0.03). Intensified counseling is recommended for pregnant women in the third trimester to realize exclusive breastfeeding. CONCLUSIONS: A positive and significant effect of breastfeeding counseling was found on the level of knowledge, attitudes, and changes in the behavior of coastal communities in exclusive breastfeeding. Show more

Keywords: Counseling, behavior, exclusive breastfeeding

DOI: 10.3233/BD-229002

Citation: Breast Disease, vol. 41, no. 1, pp. 439-445, 2022

Authors: Mamonto, Lidya | Nelwan, Berti J. | Sungowati, Ni Ketut | Miskad, Upik A. | Cangara, Muh. Husni | Zainuddin, Andi Alfian

Article Type: Research Article

Abstract: BACKGROUND: The histological tumor grade influences the prognosis of breast cancer. In metastatic breast cancer, stromal cells produce chemokine (CXC motif) ligand 12 or stromal cell-derived factor-1 as a chemoattractant, which binds to chemokine (CXC motif) receptor 4 (CXCR4) expressed by breast cancer cells. OBJECTIVE: This study aimed to determine the expression of CXCR4 in invasive breast cancer in relation to lymphovascular invasion (LVI) and lymph node metastasis. METHODS: This observational study retrospectively investigated a paraffin block archived sample diagnosed with invasive breast cancer. The results of immunohistochemical staining with CXCR4 antibody and expression analysis were …evaluated using light microscopy. The data were statistically analyzed using the chi-square test and presented in a table using SPSS version 18. P -values of <0.05 were considered statistically significant. RESULTS: The expression of CXCR4 was significantly associated with the incidence of LVI and lymph node metastasis in invasive breast cancer (both p  = 0.001). CONCLUSIONS: The results show that the expression of CXCR4 varies and support its decisive role in the incidence of LVI and lymph node metastasis in invasive breast cancer. Show more

Keywords: CXCR4, invasive breast cancer, metastasis, lymphovascular invasion

DOI: 10.3233/BD-229003

Citation: Breast Disease, vol. 41, no. 1, pp. 447-453, 2022