Breast Disease - Volume 37, issue 3

Authors: Abdeljaoued, Syrine | Bettaieb, lhem | Nasri, Meher | Adouni, Olfa | Goucha, Aida | Bouzaiene, Hatem | Boussen, Hamouda | Rahal, Khaled | Gamoudi, Amor

Article Type: Research Article

Abstract: BACKGROUND: Male breast cancer (MBC) is a rare and neglected disease. Prognostic and predictive factors in MBC are extrapoled from trials conducted on its female counterpart. OBJECTIVE: Since the relationship between the transcription factor Forkhead box M1 (FOXM1) expression and the clinical response to chemotherapy and hormonotherapy in MBC remains unknown, we sought to investigate the predictive value of FOXM1 in MBC. Methods: FOXM1 expression was assessed in 130 MBC cases. Clinical significance was analyzed by Kaplan Meier curves, log-rank test and multivariate Cox regression analyses. RESULTS: Patients with high FOXM1 expression had a …significantly lower response rate to chemotherapy (P = 0.045) and hormonotherapy (P = 0.029) than those with low FOXM1 expression. Multivariate analyses indicated that FOXM1 was an independent prognostic factor for disease free survival in MBC patients (P < 0.001). CONCLUSIONS: FOXM1 may have a reliable predictive significance in male breast cancer and thus may become an important target for male breast cancer therapy in the near future. Show more

Keywords: Forkhead box M1, FOXM1, male breast cancer, treatment resistance, therapeutic target

DOI: 10.3233/BD-170315

Citation: Breast Disease, vol. 37, no. 3, pp. 109-114, 2018

Authors: Amitai, Yoav | Golan, Orit | Barnea, Yoav | Klausner, Joseph | Menes, Tehillah S.

Article Type: Research Article

Abstract: BACKGROUND: Oncoplastic reconstruction is increasingly used in the management of women undergoing breast conserving surgery. We examined the findings on breast exam and imaging of patients who underwent breast conservation with or without oncoplastic reconstruction. OBJECTIVE: We hypothesized that patients undergoing immediate breast reconstruction would present with more palpable and imaging abnormalities compared to lumpectomy alone and undergo therefore more biopsies. METHODS: All patients undergoing breast conservation with oncoplastic reconstruction for breast cancer between 2009 and 2014 were included in the study group. The control group was created by matching 4 women that underwent lumpectomy alone …during the same week to each patient in the study group. The two groups were compared regarding demographics, tumor characteristics, post-operative complaints, breast exam, imaging and biopsies done during follow-up. RESULTS: The study group included 67 women who had lumpectomy and immediate oncoplastic reconstruction and 268 women that underwent lumpectomy alone. Patients undergoing immediate oncoplastic reconstruction had more advanced disease; larger mean tumor size (3.1 cm versus 1.9 cm, P < 0.001), higher rate of involved lymph nodes (48% versus 26%; P < 0.001) and use of neoadjuvant treatment (39% versus 15%; P < 0.001). After oncoplastic reconstruction, new lumps (18% versus 5%; P = 0.004) were found more frequently, and there was a higher rate of women undergoing biopsies (31% versus 11%; P < 0.001). This finding remained significant after controlling for age, type of tumor, use of neoadjuvant treatment and volume of tissue removed. Over ninety percent of biopsies in the oncoplastic group were benign, most commonly-fat necrosis (N = 15, 60% of the biopsies). CONCLUSIONS: Immediate oncoplastic reconstruction is associated with increased palpable masses and imaging abnormalities, requiring biopsies. Patients and clinicians should be aware of the benign nature of most of these findings. Show more

Keywords: Lumpectomy, oncoplastic reconstruction, breast biopsy

DOI: 10.3233/BD-170284

Citation: Breast Disease, vol. 37, no. 3, pp. 115-121, 2018

Authors: Mejri, Nesrine | Benna, Mehdi | El Benna, Houda | Soumaya, Labidi | Afrit, Mehdi | Zouari, Bechir | Boussen, Hamouda

Article Type: Research Article

Abstract: PURPOSE: We evaluated the relation between first site of recurrence of early breast cancer and disease profile at presentation and reported survival results, suggesting a personalized diagnostic imaging guidance during follow up. METHODS: Among 1400 early breast cancer treated from 2000 to 2010, 324 relapses were divided into 4 groups according to first site: A-locoregional, B-bone, C-Brain and D-visceral. We analyzed redictive factors of each group compared to a control group of 100 non relapsing patients and the remaining groups matched. RESULTS: In group A, patients were more likely to have histological tumor size above >2 cm, …grade 1–2, HR positive and 0–3 involved lymph nodes. In group B, patients had more commonly grade 2–3, 1–3 positive lymph nodes and HR positive tumors. In group C, patients were more frequently young, with large tumor size, grade3, positive lymph nodes and HER2 positive tumors. In group D, patients were more likely to have tumors>2 cm in size, with nodal involvement, grade 3, HR negative and HER2 positive tumors. Annual recurrence rate in group A, was stable ranging between 15%–18%, within the first 3 years and peaked at 19.4% in the interval [1–2]year in group B. Median survival was 46 months in group A, 43 months in group B, with no significant difference. CONCLUSION: Outcome of loco-regional and bone relapses was good, suggesting that both systematic mammography and bone-scan/CT scan for high risk patients (N+, gradeIII) during the first 2–3 years may represent a tailored relevant follow-up protocol for breast cancer patients. Show more

Keywords: breast cancer, follow-up, imaging, recurrence

DOI: 10.3233/BD-170290

Citation: Breast Disease, vol. 37, no. 3, pp. 123-132, 2018

Authors: Lokanatha, D. | Anand, Abhishek | Lakshmaiah, K. C. | Govind Babu, K. | Jacob, Linu Abraham | Suresh Babu, M. C. | Lokesh, K. N. | Rudresha, A. H. | Rajeev, L. K. | Saldanha, Smitha C. | Giri, G. V. | Koppaka, Deepak | Kumar, Rekha V.

Article Type: Research Article

Abstract: Introduction: Primary angiosarcoma of the breast is a rare entity with incidence of less than 0.05% of all malignant breast neoplasms. It occurs in young females without any associated risk factors. The tumor behaves aggressively and has a poor prognosis compared to invasive ductal carcinoma. Method: It was a retrospective observational study done at a tertiary cancer center from January 2012 to December 2016. The medical records of patients diagnosed with primary breast angiosarcoma were reviewed for the study. Clinicopathological profile, treatment, and the outcomes were analyzed. Results: Four patients were diagnosed with primary breast angiosarcoma …out of 2560 breast cancer patients seen over a period of 5 years. Two had metastatic disease at presentation. Among four patients, two underwent surgery of the primary tumor, whereas, all received chemotherapy either as adjuvant or palliative setting. One patient received adjuvant radiation therapy. Three patients received 2nd line and one received 3rd line chemotherapy on disease progression. After a median follow-up of 18 months one patient was surviving on 3rd line chemotherapy with trabectedin. Other three succumbed to disease after progression. Conclusion: Due to a small number of this malignancy randomized studies are difficult to perform and optimum treatment strategy still need to be defined. Show more

Keywords: Angiosarcoma, Breast cancer, Pathology, Treatment outcome

DOI: 10.3233/BD-170291

Citation: Breast Disease, vol. 37, no. 3, pp. 133-138, 2018

Authors: Efared, Boubacar | Ebang, Gabrielle Atsame | Tahiri, Layla | Sidibé, Ibrahim S. | Erregad, Fatimazahra | Hammas, Nawal | Melhouf, Moulay Abdelilah | Banani, Abdelaziz | Chbani, Laila | Fatemi, Hinde El

Article Type: Research Article

Abstract: BACKGROUND: Phyllodes tumors (PT) are uncommon biphasic tumors, accounting for less than 1% of all breast primary neoplasms. They form a wide variety of tumors ranging from benign to malignant. Several histological features are used to grade PT into 3 categories: benign (grade I), borderline (grade II) and malignant (grade III) tumors. The aim of our study was to analyse histolopathological, radiological and clinical features of PT from an experience of a single center. METHODS: It was a retrospective study including 106 patients diagnosed with phyllodes tumors on surgical specimens at the department of pathology, of Hassan II university hospital (Fez, …Morocco), from 2009 to 2016. RESULTS: The mean age was 33.81 years (range of 13–66 years), and the mean age increases with the tumor grade (mean ages of 32.32, 32.87 and 33.65 years respectively for grade I, II and III PT) (p = 0.023); 78 patients (73.58%) had benign PT, 20 (18.86%) had borderline PT and 8 (7.54%) patients were diagnosed with malignant PT. Mostly, the tumor size was <5 cm (63.2%), with BI-RADS 3 (51 patients, 48.11%). The tumor size and the radiological suspicion (ACR/BI-RADS) increased with the tumor grade (p < 0.001). Mitosis count, cellular atypia and stromal cellularity increased with the tumor grade (p < 0.001). Also, the presence of necrosis is associated with malignant PT (p < 0.001). Before surgery, patients had undergone core needle biopsies (CNB) for diagnostic purpose, and the overral sensitivity of this diagnostic procedure was 71.83%. The sentivity of the CNB decreased from grade I PT to grade III PT (from 56.81% to 37.5%), however its specificity increased from grade I to grade III PT (from 59.25% to 100%). CONCLUSION: Phyllodes tumors of the breast are rare neoplasms with a wide range of clinicopathologic presentations. The core needle biopsy has a good diagnostic sensitivity compared to definitive diagnosis on surgical specimens. There was a statistically significant association between the histological grade of PT and tumor size, radiological suspicion, mitotic count, cellular atypia, stromal cellularity, and tumor necrosis. Show more

Keywords: Breast, phyllodes tumor, pathology

DOI: 10.3233/BD-170297

Citation: Breast Disease, vol. 37, no. 3, pp. 139-145, 2018

Authors: Nahleh, Z. | Botrus, G. | Dwivedi, A. | Badri, N. | Otoukesh, S. | Diab, N. | Biswas, S. | Jennings, M. | Elzamly, S.

Article Type: Research Article

Abstract: BACKGROUND: Breast cancer is the leading cause of cancer death in Hispanic/Latina women nationwide. Limited cancer research has been conducted in this population. El Paso, Texas is a large border city with a population of around 900,000, of which 85% are Latinos and would provide a suitable setting for this study. The aim of this study is to evaluate ethnic differences and cancer characteristics in Hispanic/latina women with breast cancer. METHODS: After IRB approval, we retrospectively analyzed the variables of patients with breast cancer treated consecutively at a large tertiary medical center in El Paso, TX between 2005–2015. …Descriptive statistics, bivariate, and multivariable analyses were conducted. RESULTS: 1,252 patients were identified. Mean age at diagnosis was 57 years. 1074 were Hispanics/Latinas (86%). When comparing Hispanics versus non-Hispanics, 31% of Hispanics compared to 24% Non-Hispanics were diagnosed at age <50 (P = 0.043). More Hispanics are uninsured (34%) compared to Non-Hispanics (25%) (p = 0.008). Hispanics presenting with advanced stages were more likely to be uninsured (P = 0.02). CONCLUSIONS: This analysis confirms that Hispanics/Latinas are diagnosed with breast cancer at a younger age and are more commonly uninsured than Non-Hispanics. We did not observe significant differences in the prevalence of ER +, triple negative or Her2 -neu positive disease or stages at presentation between the 2 groups in this cohort, however the non-Hispanic group was constituted only 14% of the studied population. A larger multi-institutional comparative study is being conducted to confirm these findings. Show more

Keywords: breast, cancer, Hispanic, ethnic

DOI: 10.3233/BD-170309

Citation: Breast Disease, vol. 37, no. 3, pp. 147-154, 2018

Authors: Bezic, Josko | Srbljin, Jelena

Article Type: Case Report

Abstract: Pseudoangiomatous stromal hyperplasia (PASH) is a breast stromal change, histologically characterized by anastomosing, slit-like spaces lined by slender myofibroblasts and surrounded by dense collagenous stroma. Mass forming cases clinically and radiologically simulate fibroadenoma. A middle aged women presented with unpalpable breast nodule discovered on ultrasound examination. The ultrasound characteristics were typical for fibroadenoma, while fine-needle aspiration cytology was inconclusive. The histological examination of the lumpectomy specimen showed fibroadenoma with peculiar stromal alteration consistent with pseudoangiomatous stromal hyperplasia. The presented case of fibroadenoma with pseudoangiomatous hyperplasia within its stroma demonstrates the relationship between these two entities not only clinically and radiologically, …but also histologically. Show more

Keywords: Breast, fibroadenoma, PASH

DOI: 10.3233/BD-170281

Citation: Breast Disease, vol. 37, no. 3, pp. 155-157, 2018

Authors: Jaseem Hassan, Mohammad | Sharma, Monika | Khetrapal, Shaan | Khan, Sabina | Jetley, Sujata

Article Type: Case Report

Abstract: Crystallizing galactocele is a very rare entity which yields a viscous, chalky material on Fine Needle Aspiration Cytology (FNAC). FNAC is used both for diagnosis as well as treatment of this condition. We present here a case of 26 years old lactating female who presented with swelling in the right breast for 8 months. The swelling was firm, discrete, non-tender and mobile involving the upper inner quadrant of right breast. A diagnosis of benign breast disease, possibly fibroadenoma was made clinically. FNAC of the lesion yielded thick, milky and chalky material. Cytological smears showed numerous semitransparent crystals of varying size …and shapes with angulated borders in a background of granular and amorphous debris along with frothy appearing micelles. These crystals show positive birefringence. Based on clinical history of lactation and typical cytological findings, a diagnosis of crystallizing galactocele was made. We report this case because of rarity of this condition and to the best of our knowledge, till date only five cases of crystallizing galactocele has been reported in medical literature. Show more

Keywords: crystallizing, lactation, pregnancy, galactocele

DOI: 10.3233/BD-170295

Citation: Breast Disease, vol. 37, no. 3, pp. 159-161, 2018

Authors: Tandon, Megha | Panwar, Pankaj | Kirby, R. M. | Narayanan, Sankaran | Soumian, Soni | Stephens, Mark

Article Type: Case Report

Abstract: Metastases to the breast are very uncommon as compared to primary tumours. Breast is an unusual site for metastasis from renal cell carcinoma. Only occasional cases are reported in the literature. These metastases must be clearly diagnosed as the treatment of primary breast cancer and metastases differs markedly. Treatment of isolated metastases from renal cell carcinoma is usually surgical resection. We report two cases of isolated metachronous metastases to breast from renal cell carcinoma.

Keywords: Renal Cell Carcinoma (RCC), primary breast carcinoma, metachronous, isolated metastasis

DOI: 10.3233/BD-170294

Citation: Breast Disease, vol. 37, no. 3, pp. 163-167, 2018

Authors: Salemis, Nikolaos S.

Article Type: Case Report

Abstract: Metaplastic carcinoma of the breast with mesenchymal differentiation (MCMD), previously known as carcinosarcoma, is a very rare and aggressive tumor that has been recently classified as a subtype of metaplastic breast carcinoma. It accounts for 0.08%–0.2% of all breast cancers, with only a few cases reported in the literature. Histologically, MCMD is characterized by a biphasic pattern of malignant epithelial and sarcomatous components without evidence of a transition zone between the two elements. We herein describe a unique case of metaplastic carcinoma of the breast with chondrosarcomatous differentiation in a postmenopausal woman who presented with a large, rapidly growing, ulcerated, …bleeding mass and signs of impending sepsis. Metaplastic breast carcinomas (MBC) are rare and aggressive tumors. They are characterized by larger size, lower rates of axillary node involvement, higher rates of triple negativity and distal metastases, earlier local recurrence and poorer survival compared with classic invasive breast cancer. Because of the rarity of MBC, the optimal treatment has not been well defined. Surgery is the main curative treatment modality since MBC has shown a suboptimal response to standard chemotherapy. Patients with MBC may be appropriate candidates for novel targeted therapies. Show more

Keywords: breast, carcinoma, carcinosarcoma, differentiation, metaplastic, mesenchymal

DOI: 10.3233/BD-170313

Citation: Breast Disease, vol. 37, no. 3, pp. 169-175, 2018