Spindle cell carcinoma of the breast: a case study report from Mankweng hospital & literature review

We report a unique case of a 67-year-old woman with neurofibromatosis type 1, who was also diagnosed with metaplastic spindle cell carcinoma of the left breast. She had many neurofibromatosis lesions on her body, as well as the mass in the left breast. After the breast mass was diagnosed as a malignant mesenchymal tumor by core needle biopsy, the patient underwent left modified radical mastectomy. Subsequently, the pathological analysis of the tumor showed it to be a metaplastic spindle cell carcinoma. The co-occurrence of neurofibromatosis type 1 and breast cancer, in particular metaplastic spindle cell carcinoma, is very rare.

Metaplastic breast carcinoma is uncommon, constitutes ≤ 5% of all breast cancers, and is classified into various subtypes with varying incidences. Of these subtypes, spindle cell carcinoma represents approximately 0.3% of all invasive breast carcinomas in women. The spindle cell carcinoma subtype of metaplastic breast carcinoma is typically triple negative and has distinct clinical, radiological, and pathological characteristics. To date, there is no effective treatment for this malignancy. Herein, we report a case of spindle cell carcinoma of the breast in a 71 year-old man who presented with a palpable mass in his left breast. Breast ultrasonography revealed a 1.1 × 2.6 cm hypoechoic welldemarcated ovoid mass. The patient underwent excisional biopsy. Pathological findings indicated a diagnosis of spindle cell carcinoma of the breast, and the patient underwent a modified radical mastectomy. The final pathological report indicated a 6.5× 3.0 cm malignant spindle cell tumor.

To describe the morphologic features and immunohistochemistry of spindle cell carcinoma of breast with neuroendocrine differentiation. Retrospective review of 2500 cases of breast carcinoma showed 5 cases (0.2%) with a predominance (> 80%) of spindle cell component. Amongst the 5 cases studied, 2 represented intraductal spindle cell carcinoma and 3 represented invasive spindle cell carcinoma. The paraffin sections were stained with hematoxylin and eosin, alcian blue, periodic acid-Schiff and reticulin stain. Immunohistochemical studies for AE1/AE3, CEA, EMA, CK7, 34betaE12, NSE, synaptophysin, chromogranin A, Leu-7, vimentin, S-100, SMA, calponin, estrogen receptor, progesterone receptor, c-erbB2, E-cadherin, Ki-67 and p53 were also carried out. Follow-up information was available in 4 of the 5 cases. The mean age of the patients was 68 years. Histologically, all tumors were predominantly composed of elongated spindle cells. Three of these cases also contained tumor cells with vacuolated cytoplasm, alcian blue-positive tumor cells were observed in 4 cases. Immunohistochemically, the spindle tumor cells in all cases expressed AE1/AE3, CEA, EMA, E-cadherin and synaptophysin. CK7 was positive in 4 cases, NSE in 3 cases, chromogranin A and Leu-7 in 2 cases. Estrogen receptor was expressed in 4 cases and progesterone receptor in 2 cases. Overexpression of c-erbB2 oncoprotein was detected in only 1 case. Vimentin was focally positive in 1 case. Two cases of intraductal spindle cell carcinoma and 1 of the 3 cases of invasive spindle cell carcinoma were classified as neuroendocrine carcinoma of spindle cell type, while the remaining 2 cases of invasive spindle cell carcinoma were considered as metaplastic carcinoma with neuroendocrine differentiation. Amongst the 4 patients with follow-up information available, 3 were still alive 24 to 58 months after the initial diagnosis. One patient died within 27 months of diagnosis. The presence of spindle tumor cells and sometimes intracytoplasmic mucin are useful morphologic clues in diagnosing spindle cell carcinoma of the breast with neuroendocrine differentiation. Intraductal neuroendocrine spindle cell carcinoma needs to be distinguished from usual ductal hyperplasia and intraductal papilloma. On the other hand, invasive spindle cell carcinoma with neuroendocrine differentiation needs to be distinguished from spindle cell myoepithelioma, malignant melanoma and sometimes soft tissue neoplasm.

患者女,66岁.发现右乳肿块4 d,无疼痛和溢液,于2009年11月30日收入院.体检:双乳对称,无乳头凹陷,右乳内下4点距乳晕3 cm处有酒窝征,触诊可扪及一个约2.5 cm×2.0 cm×2.0 cm的质硬肿块,界限不清,活动可,无触痛,按压时无乳头溢液.左乳未触及明显肿块。

Spindle cell carcinoma of breast in a 36 year old female: A case report with Review of Literature

Breast cancer remains the most common cancer in many parts of the world, particularly for women. In March 2015, a Breast Oncology clinic for breast cancer patients was established at Mankweng Hospital. Invasive ductal carcinoma is the most common (87 %) tumour found in Limpopo, and occasionally, another rare tumour of the breast is presented in the Breast Oncology clinic. The aim: The main objective is to share the experience of a rare tumour of the breast came across over the past 8 years since the establishment of the Breast Oncology clinic. Material and Method: Series of rare case reports of Breast tumours and literature review from the Mankweng Breast Oncology Clinic. Result: Rare tumour encountered in Breast Oncology clinic: adenomyoepithelioma, micro-papillary carcinoma of the breast, primary malignant melanoma of the breast, primary non-Hodgkin's lymphoma of the bilateral breast, advanced breast cancer in a case of Down's syndrome, primary neuroendocrine invasive breast carcinoma, sarcoma of the breast. Conclusions: Most of these rare cases are presented to the Breast Oncology clinic in the advanced stage. Breast cancer awareness campaign is highly important for women in Limpopo, particularly when attending primary health care for any other conditions.

Adenoid cystic carcinoma of the breast is a rare breast malignancy. To our knowledge, only 140 cases have been reported in the English literature and no similar cases have been reported in Taiwan. A51-year-old woman presented with a left breast lump. During operation, the lesion was found to be a cystic mass with granulation growth. Frozen section of the excised tumor revealed infiltrating ductal carcinoma of the breast. She underwent Patey's type modified radical mastectomy. Pathological diagnosis was adenoid cystic carcinoma of the breast. She remains disease-free 25 months after operation, without adjuvant therapies.

Background: Based on data from the World Health Organisation, it has been shown that Novel Corona virus pandemic disrupts normal activity in whole world. Lockdowns are known to reduce the transmission of virus and enforced almost in the entire world based on countries recommendations. In South Africa, lockdown measures were imposed from 26th March 2020 and health care services became seriously affected particularly elective surgical operations. Objectives: Main aim of the study is to estimate the effect of lockdown on the general surgery services in Mankweng hospital. Method: This is a retrospective cross sectional observational descriptive study. Data for study include admission, operation & attendance to outpatient clinic collected during a lockdown period of 3 months(April-June 2020) and normal period of 3 months(April-June 2019) from Mankweng Hospital Information System.
 Result: During the lockdown period April-June 2020, total 291 patients were seen in Surgical Outpatient Department and 122 in Breast Oncology Clinic. There were 197 patients admitted to the hospital and 120 operations performed in theatres. During April-June in 2019, total 442 patients were seen in Surgical Outpatient Department and 152 in Breast Oncology Clinic. There were 500 patients admitted to the hospital and 166 operations performed in theatres. During lockdown elective general surgery operations were reduced noticeably. Conclusions: Restoration of elective operations should start as soon as Corona virus pandemic slows down and extra elective theatre list should be enrolled during weekends to reduce the backlog at least for few months.

Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position. A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter. There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant. BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.

Technical Challenges of Heart Avoidance for Synchronous Breast and Lung Cancers in a Postmenopausal Female: A Planning Case Report From a Safety-Net Hospital

Introduction: According to World Health Organization data, the Novel Corona virus pandemic disrupts normal activity throughout the world. Lockdowns are known to reduce virus transmission and are enforced almost everywhere in the world. Lockdown measures were implemented in South Africa on March 26th, 2020. Health care services affected seriously particularly the surgical care. Then, second wave hit of COVID-19 in January 2021, restricted elective operation furthermore.  Main aim of the study is to estimate the effect of corona pandemic on the general surgery operations in Mankweng hospital and remedy for impact. Methods: This is a retrospective cross sectional observational descriptive study. Admission, operation, and outpatient clinic data were collected from the Hospital Information System and theatres during a three-month lockdown period (April-June 2020) and a three-month normal period (April-June 2019). Results: During the lockdown period of April to June 2020, 291 patients were seen in the Surgical Clinic and 122 in the Breast Oncology Clinic. There were 197 patients admitted, and 120 operations were performed. For comparison, during the months of April to June of 2019; total 442 patients were seen in the Surgical Clinic and 152 in the Breast Oncology Clinic. 500 patients were admitted, and 166 operations were performed. Conclusion: During corona pandemic elective general surgery operations were reduced noticeably. Restoration of elective operations should start as soon as Corona virus pandemic slows down and extra theatre list should be continued during weekends to reduce the backlog at least for next few months and increase the outreach surgical operations in district and regional hospital.

Metaplastic carcinoma of breast (MCB) is a rare breast malignancy. It is important to differentiate metaplastic carcinoma from malignant phyllodes and primary breast sarcomas because of their differing biological behavior and prognosis. We report four cases of MCB diagnosed over the past 15 years. Retrospective review of patient records in a tertiary care setting to retrieve cases diagnosed as MCB. Patient records of the past 15 years (2002–2015) were retrieved. Four histopathologically diagnosed cases of metaplastic carcinoma out of a total of 880 archived cases of breast carcinoma were studied along with their cytopathology. Immunohistochemistry was performed on sections. MCB comprised 0.45% of all breast malignancies. The four cases of MCB included MCB with chondroid metaplasia, spindle cell carcinoma, adenosquamous carcinoma, and carcinosarcoma. All the tumors were invariably triple negative (estrogen receptor, progesterone receptor, and Her2/Neu negative) and expression of other epithelial and mesenchymal markers was variable. MCB is a rare breast malignancy. Differential diagnosis is related to the presence of heterologous elements and degree of atypia seen in the lesion. It is important to be aware of this entity as it carries a poor prognosis.

Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position. A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter. There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant. BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.

Objective To explore the correlation between breast ultrasound typing and breast cancer risk factors in different age groups. Methods Five hundred women (2 of whom were diagnosed with breast cancer) who underwent breast color doppler ultrasonography at our hospital from January, 2017 to December, 2018 were selected. The relevant data of all the subjects were collected by questionnaire survey. The results of breast ultrasound typing and the related factors affecting breast ultrasound typing in each age group were analyzed. Results There were statistical differences in the breast ultrasound types. In the over 35 years old group, most ductal type breast occurred the unmarried ones, mixed type in the ones with good emotion, and dense type in the depressed ones, and heterogeneous breast correlated with BMI. In the 35-55 years old group, dense breast correlated with ones’ emotion, breast feeding history, and aspiration biopsy, and most heterogeneous breast occurred in the ones with BMI≥28 kg/m2. In the ≥55 years old group, the breast ultrasound type correlated with ones’ psychological status and BMI. Conclusion Breast ultrasound type correlates with female breast cancer risk factors, such as ones’ psychological status and BMI. parenchymal ultrasonography is correlated with risk factors of breast cancer in women, and breast ultrasonography is closely correlated with psychological status and BMI. 35 to 55 years old women have most risk factors affecting breast ultrasound type. Breast ultrasound examination can provide some references for female breast tissue and breast cancer risk correlation. Key words: Age; Breast ultrasound typing; Risk factors for breast cancer; Correlation

Background: Breast cancer is a diverse disorder, commonly occurs in elderly women in Europe and America. However, in Africa, it happens often among younger women. Main aim of the study is to have better understand the characteristics of breast cancer in women under 50 years and to identify any differences exist between HIV positive and negative groups of breast cancer patients. Method: Retrospective descriptive quantitative study intended to analyse the profile of women under 50 years old with breast cancers who attended Breast Oncology Clinic, Mankweng Hospital from July 2020 to December 2021. Results: Total 109 breast cancer patients evaluated. Mean age in HIV negative 40.6 and HIV positive 39 years. HIV status: HIV Positive 28(25.7%). HIV Negative 81(74.3%). HIV positive group: Molecular subtype: Luminal A:5(24%), Luminal B:8(38%), HER2+ overexpression:3(14%), Triple negative:5(24%). Stage: Early stage 6(21%), late stage 22(79%). HIV negative group: Molecular subtype: Luminal A:16(22%), Luminal B:41(58%), HER2+ overexpression:7(10%), Triple negative:7(10%). Stage: Early stage 16(20%), late stage 65(80%). Conclusion: Majority of breast cancer patients presented in advance stage in both HIV positive and negative group. Mean age of HIV positive slightly younger than HIV negative (39-year vs 40.6 years). Triple negative molecular subtype was proportionately more in HIV-positive group in compared to HIV-negative patients. Initiative of Routine breast cancer screening should take place on this population of women under 40-year age.