Case Of Bilateral Breast Cancer Research Articles

異時性両側男性乳癌の1例

異時性両側男性乳癌の1例

An unusual case of advanced bilateral male breast cancer

Background: Breast cancer in men is a rare malignancy. The majority institutions involved in treatment of male patients with breast cancer do not have a wide experience as it is mostly based on single cases rather than clinical studies. Case report: We report an unusual case of a 46 years old male patient presenting with a 6 years history of breast cancer. The patient was diagnosed with cancer of the left breast and surgically treated with modified radical mastectomy with no axillary dissection in the district general hospital. The reason for not doing axillary dissection is unknown. Adjuvant therapy consisted of 4 x EC, radiotherapy and tamoxifen. 2 years later there was a local recurrence in the area surrounding mastectomy scar and skin metastases on the chest wall as the most dominant clinical sign. The patient underwent axillary dissection and rotating plastics and continued to be treated with chemo-and endocrine therapy. Later local recurrences and progression of skin metastases were treated with various systemic and local chemotherapies, and intraarterial administration of chemotherapy. 5 years later the patient was also diagnosed with inflammatory cancer in the right breast. Further progression of disease affected the chest walls along with consequent limitations of the movements of the neck and the left arm. Two months prior to death liver metastases were detected. Conclusion: In case of male breast cancer surgical treatment including axillary dissection and adjuvant therapy are necessary as it is equally required in treatment of female patients with breast cancer

Quimioterapia neoadyuvante como tratamiento del carcinoma lobulillar mamario. ¿Ha llegado el momento del cambio?

Benefits of primary chemotherapy in cases of breast invasive ductal carcinoma are widely accepted. However, the use of this therapy is controversial in cases of lobular invasive carcinoma: response rates are very poor–but not prognosis– and cases in which the breast can be conserved are very few. We present a rare case of bilateral synchronous breast cancer, a ductal carcinoma in the right breast and a lobular carcinoma in the left breast. It illustrates very clearly the controversy in which we currently are.

The alternation of estrogen receptor (ER) and progesterone receptor (PgR) expression in primary breast cancer patients treated with neoadjuvant chemotherapy (NAC)

21165 Background: Currently, neoadjuvant chemotherapy (NAC) for the operable primary breast cancer has become standard treatment strategy. Primary treatment could affect the status of Estrogen receptor (ER) and Progesterone receptor (PgR) expressions in the tumor, and might have impact on the choice of adjuvant hormone therapy. Methods: We evaluated consecutive 165 primary breast cancer cases those treated with 4 cycles of FEC (500–100–500 mg/m2, q3wks) followed by 4 cycles docetaxel (75 mg/m2, q3wks) as their neoadjuvant treatment in our institution from January 2000 to February 2006. Except for the bilateral breast cancer cases and patients achieved pCR, 107 pairs of core needle biopsy before treatment and tumor block after surgery were evaluated by immunohistochemistry (IHC) for receptor status and analyzed by Allred scoring. Score 4 or more was designated as positive. Results: Median age of patients was 51 (23–71) years old. Hormone receptor (HR) phenotypes before treatment were following; ER+/PgR+:62(57.9%), +/ -:23(21.5%), -/ +:2(1.9%), -/ -:20(18.7%). As the HR status, 94.4 % of patients did not show any alternation for their HR evaluation. Only 4.7% of patients experienced changes from HR+ to HR-, and HR- to HR+ were extremely rare (0.9%). Although ER positivity was not changed in most of cases (95.1%), conversion from PgR + to - were observed in 35.5% of ER+/PgR+ cases. Particularly, the rate of negative conversion of PgR were found more frequently in patients with age under 50 (51.7% in <50y.o. vs. 22.6% in =50 y.o., p=0.03). Whereas, in older patients, negative conversion of PgR correlated to favorable pathological response. Conclusions: In most of patients, neoadjuvant chemotherapy did not affect the evaluation of HR status. Alternation of PgR expression seems to reflect the chemotherapy induced amenorrhea in younger patients. In the older patients, negative conversion of PgR may have some impact on pathological response. No significant financial relationships to disclose.

Use of Ultrasonography as an Alternative Modality as a First-Line Examination in Detecting Breast Cancer in Selected Patients

Background Detecting lesions in dense breast tissue can be difficult when using mammography. If a patient can be identified as having an increased likelihood of having dense breast tissue based on background factors, ultrasonography can be selected as an alternative method to detect lesions efficiently. We focused on age and reproductive history as factors that determine whether mammography or ultrasonography should be used first. Patients and Methods We retrospectively examined 193 breasts in 192 patients (1 case of bilateral breast cancer) who had undergone surgery and received a histopathologic diagnosis of breast cancer. Patients were divided into the 2 following groups based on age: 40–49 years and ≥ 50 years. These groups were then subdivided based on reproductive history as follows: no history of pregnancy, < 3 parturitions (excluding no history of pregnancy), and ≥ 3 parturitions. Sensitivities were then compared among the 6 groups. Results Significant differences in sensitivities were found between mammography and ultrasonography in 3 groups: patients aged 40–49 years with no history of pregnancy; patients aged 40–49 years with a history of < 3 parturitions; and patients aged ≥ 50 years with no history of pregnancy. Limiting the results to these groups, sensitivities were 51.5% (34 of 66 cases) with mammography and 81.8% (54 of 66 cases) with ultrasonography. Conclusion We suggest that ultrasonography be used as a first-line examination in detecting breast cancer in such patients; however, this must be confirmed in a future upscale study using larger numbers of subdivided groups.

Multifocal Male Breast Cancer: A Case Report

Breast cancer among men is rare and accounts for < 1% of all breast cancer diagnoses. We report a 75-year-old man who presented with a painless breast lump and was found to have 2 separate foci of cancer in the same breast. Several cases of bilateral male breast cancer exist in the literature, but we are not aware of any previous reports of multifocal male breast cancer. Key issues surrounding the diagnosis and treatment of multifocal male breast cancer are discussed.

Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer

A regional nodal recurrence is a major concern after a sentinel lymph node biopsy (SLNB) alone in patients with breast cancer. In this study we investigated patterns and risk factors of regional nodal recurrence after SLNB alone. Between January 1999 and March 2005, a series of 1,704 consecutive breast cancer cases in 1,670 patients (34 bilateral breast cancer cases) with clinically negative nodes or suspicious nodes for metastasis who underwent SLNB at a single institute (Saitama Cancer Center) were studied. All 1,704 cases were classified based upon presence or absence of a metastatic lymph node, treated with or without axillary lymph node dissection (ALND). The site of first recurrence was classified as local, regional node, or distant. The regional node recurrences were subclassified as axillary, interpectoral, infraclavicular, supraclavicular, or parasternal. After a median follow-up period of 34 months (range, 2-83 months), first recurrence occurred in local sites in 32 (1.9%) cases, regional nodes in 26 (1.5%) cases, and distant sites in 61 (3.6%) cases. In 1,062 cases with negative nodes treated without ALND and 459 cases with positive nodes treated with ALND, 11 (1.0%) and 15 (3.3%) recurred in regional nodes, respectively, and 4 (0.4%) and 2 (0.6%) recurred in axillary nodes, respectively. Of 822 cases of invasive breast cancer with negative nodes treated with SLNB alone, 10 (1.4%) recurred in regional nodes, and 4 (0.5%) recurred in axillary nodes. In the 10 patients with regional nodal failure, all of the tumors were negative for estrogen receptor (ER) and/or progesterone receptor (PR) and were nuclear grade (NG) 3. The axillary recurrence rate was low in patients treated with SLNB alone. Omitting ALND is concluded to be safe after adequate SLNB. Risk factors for regional nodal failure after SLNB alone are negative hormone receptor status and high NG.

Application of BRCA1 and BRCA2 mutation carrier prediction models in breast and/or ovarian cancer families of French Canadian descent

The BRCAPRO, Couch, Myriad I and II, Ontario Family History Assessment Tool (FHAT), and Manchester models have been used to predict BRCA1 or BRCA2 mutation carrier status of women at high risk for developing the heritable form of breast and ovarian cancers. We have evaluated these models for their accuracy in classifying 224 French Canadian families with at least three cases of breast cancer (diagnosed before the age of 65 years), ovarian cancer, or male breast cancer where mutation status was known for an index affected case used to assess the model. This series includes 44 BRCA1 and 52 BRCA2 mutation-positive families. Using receiver operator characteristics analyses, the C-statistics were found to be 0.81, 0.80, 0.79, and 0.74 for the BRCAPRO, FHAT, Manchester, and Myriad II models, respectively, when incorporating both BRCA1 and BRCA2 mutation carrier predictions. For the BRCAPRO model, 75% scored greater than a 0.43 probability in the mutation-positive group and 75% scored less than 0.50 in the mutation-negative group. Only 38 of 128 (30%) mutation-negative group had a probability greater than 0.43 with the BRCAPRO model. While all models were highly predictive of carrier status, the BRCAPRO model was the most accurate where a cut-off of 10% would have eliminated 60 of 128 (47%) mutation-negative families for genetic testing and only miss 10 of 96 (10%) mutation-positive families. A review of the cancer phenotypes with high BRCAPRO probabilities showed that significantly more metachronous bilateral breast cancer cases occurred in BRCA1/2 mutation carrier families in comparison to mutation-negative families, a feature which is not discriminated in the BRCAPRO model.

A case of metachronous bilateral Breast Cancer with bilateral radiation pneumonitis after breast-conserving therapy

We report a patient with metachronous bilateral breast cancer who has twice developed radiation pneumonitis after breast-conserving therapy for each breast. The patient was a 48-year-old woman, who presented with Stage I right breast cancer. After wide excision of the right breast tumor and dissection of level I axillary lymph nodes, systemic therapy with oral 5-FU and tamoxifen was started. Subsequently, tangential irradiation with a total dose of 50 Gy in 25 fractions was given. Seven months after irradiation, she developed respiratory symptoms and radiation pneumonitis was diagnosed. The symptoms resolved with oral prednisolone. Thirty months after the right breast cancer treatment, Stage I left breast cancer was diagnosed. After wide excision of the left breast tumor and partial removal of the level I axillary lymph nodes, the same oral systemic chemo-hormonal therapy was initiated. Thereafter, tangential irradiation with a total dose of 50 Gy in 25 fractions was given. Four months after irradiation, she developed respiratory symptoms. A chest X-ray showed an area of increased density in the left lung consistent with radiation pneumonitis. The symptoms were mild and they improved spontaneously without medication. Although there is insufficient evidence to justify or withhold whole breast radiation therapy from patients with a history of contralateral breast cancer and radiation pneumonitis, it is essential to discuss the adequacy of whole breast irradiation and the possibility of alternative approaches, such as breast-conserving surgery without irradiation or partial breast irradiation for this rare condition.

Infiltrating ductal carcinoma of male breast: A retrospective study

10753 Background: A single-institution retrospective review of the clinical presentation, treatment and outcome of male breast infiltrating ductal carcinoma (IDC). Methods: Case records of 25 male patients with a histological diagnosis of infiltrating ductal carcinoma (IDC) of breast who were treated in a single institution between 1997 to 2004 were retrospectively reviewed. Results: Patients presented at a mean age of 56 years (range, 34 to 80 years). The presenting complaint was a painless lump in the breast in all the cases. The right breast was involved in 13 cases (52%). There were no cases of bilateral breast cancer. The distribution of patients by stage at presentation are: stage IIA (24%), IIB (20%), IIIA (8%), IIIB (40%), and IV (8%). None of the patients presented with stage I disease. One patient had lung metastases at presentation. Rest of the 24 patients (96%) underwent surgery (modified radical mastectomy, 22 patients; simple mastectomy, 2 patients). Fifteen patients (60%) received adjuvant local radiotherapy. All patients received adjuvant chemotherapy: As per departmental protocol, those presenting before 2000 were treated using a regimen of Cyclophosphamide, Adriamycin and 5-Fluorouracil. After 2000, Ebirubicin was substituted for Adriamycin. Three patients were further administered Docetaxel, the indication being disease progression after first line adjuvant chemotherapy. Estrogen &amp; Progesterone receptor positivity was 64% and 60% respectively. Hormonal therapy (Tamoxifen 14 patients, Anastrozole 2 patients) was administered in these patients. The length of follow-up from time of presentation ranged from 4 to 100 months (mean, 28 months; median, 13 months). At the time of analysis, of the 25 patients, 18 patients (72%) remain disease free, whereas 7 patients (28%) developed progressive disease. Median survival was not reached at the present time. Conclusions: Breast cancer, specifically IDC tends to present at a later stage in males, due to a lack of screening for the disease. In the present series, as a result of the advanced stage of initial presentation, all patients received adjuvant chemotherapy. There is a need to improve awareness among males, of the possibility of a painless breast lump being the first symptom of an underlying malignancy. No significant financial relationships to disclose.

Synchronous Bilateral Breast Carcinoma in a 50-Year-Old Man with 45,X/46,XY Mosaic Karyotype: Report of a Case

We report a case of synchronous bilateral breast cancer in a patient with ambiguous external genitalia attributed to a 45,X/46,XY mosaicism. To our knowledge, this represents the first such case ever to be reported. Mammography, ultrasonography, computed tomography, and magnetic resonance imaging all showed bilateral suspicious breast masses with microcalcifications. There were no radiological findings of muscle invasion or axillary lymphadenopathy. The patient was successfully treated by bilateral radical modified mastectomy followed by external irradiation and adjuvant endocrine therapy. Histological examination revealed a bilateral ductal carcinoma in situ, with a cribriform and papillary pattern and microfoci of infiltrating ductal carcinoma. The hormonal profile revealed high levels of follicle-stimulating hormone and luteinizing hormone, and low levels of testosterone. Testicular sonography revealed small hypoechoic testicles with bilateral microlithiasis. This case shows that 45,X/46,XY men may have an increased risk of breast cancer and must be followed up carefully.

A case of bilateral breast cancer with Peutz–Jeghers syndrome

We report the case of a 30-year old woman, who was diagnosed with Peutz–Jeghers Syndrome (PJS) at the age of 12 when she presented with small intestinal intussusception. Her supervising physician referred her for complete gastrointestinal and extraintestinal malignancy screening in keeping with PJS management guidelines. Screening mammography revealed extensive bilateral microcalcifications, proven to be high grade ductal carcinoma in situ (DCIS) by stereotactic core biopsy. She opted for bilateral skin-sparing mastectomy, with immediate latissimus dorsi flap reconstruction.

Interaction between CHEK2 *1100delC and other low-penetrance breast-cancer susceptibility genes: a familial study

The allele CHEK2*1100delC doubles the risk of breast cancer in unselected women, but could confer a greater risk in women with a family history of the disease, particularly of bilateral breast cancer. Our aim was to measure the risk of breast cancer in relatives of women with bilateral breast cancer who were carriers of this allele. A population-based series of 469 bilateral breast cancer cases ascertained through English cancer registries were genotyped for CHEK2*1100delC. Standardised incidence ratios (SIRs) and cumulative risks were calculated for breast cancer, prostate cancer, and all other cancers in the first-degree relatives of carriers and non-carriers. The relatives of bilateral cases who were wild-type for CHEK2 had three times the population risk of female breast cancer (145 cases: SIR 3.48 (95% CI 2.96-4.09), twice the risk of prostate cancer (34 cases: SIR 2.41, 1.67-3.36) and a large excess of male breast cancer (five cases: SIR 15.06, 4.92-35.36). Relatives of those who were carriers of CHEK2*1100delC had a substantially higher risk of breast cancer (eight cases: SIR 12.11, 5.23-23.88) and possibly prostate cancer (two cases: SIR 9.87, 1.20-35.67). These data suggest a multiplicative interaction between CHEK2*1100delC and other unknown susceptibility genes. In women with a family history of bilateral disease, CHEK2*1100delC confers a high lifetime risk and might be useful for predictive testing. Bilateral breast cancer cases and their families are likely to provide an efficient basis for identification of additional low-penetrance breast-cancer genes.

Population-based identification and characterization study of patients at-risk for hereditary breast cancer in in Southern Brazil: Preliminary results

9664 Background: Hereditary breast cancer (HBC) accounts for only 5–10% of all breast cancer cases (BC) in most populations. In Rio Grande do Sul (RS), BC is the first cause of all deaths in young women (30–49 years). This study will examine the contribution of genetic risk factors to this observation. Methods: A target sample of all 10,000 women residing in a specific area of Porto Alegre will be characterized for HBC risk factors. Results: Currently, 2500 of these women were recruited and submitted to an HBC risk-questionnaire to assess presence of: a) 1st degree relative with BC and/or OC; b) male relative with BC; c) relative with BC under age 50; d) 2 or more relatives with BC and/or OC; e) relative with bilateral BC; f) relative with both breast and ovarian cancer. Sixteen percent of these women reported at least one of these risk factors and were called for a genetic evaluation. Of these, 118 families were evaluated so far. Regarding specific risk factors, 43% reported at least one 1st degree relative with BC and/or OC; 50% at least one relative with BC before age 50, and 6% at least one relative with bilateral BC. The average lifetime risk of breast cancer for these patients by the Gail and Claus models was 11,34% and 13,73% respectively. The estimated average mutation probability in these genes was 11,77% and 28/118 families (23%) had a >20% chance of carrying a mutation. When criteria for other breast cancer predisposition syndromes was analysed, we found that 6/118 (5%) families fulfilled criteria for the Li-Fraumeni-like syndrome. Finally we compared the lifetime risk estimates for BC obrtained during the initial visit with that obtained after confirmation of family history with medical records. Risk was stratified in three categories: low (< 10%), medium (10–30%), and high (> 30%). In an initial evaluation, risk was as follows: low 63,25%, medium 26,5% and high in 10,25%; after confirmation of family history, these figures were 78,55%, 10,53% and 10,53%, respectively. There was concordance in initial and final risk estimates in 87% of patients. Conclusions: Results of this study will influence the delineation of specific BC prevention strategies for the local community. No significant financial relationships to disclose.

NBS1 657del5 mutation may contribute only to a limited fraction of breast cancer cases in Russia

The gene for Nijmegen chromosomal breakage syndrome (NBS1) plays a role in a variety of processes protecting chromosomal stability. Recently, it was suggested in a Polish case-control study that the founder hypomorphic mutation in NBS1, 657del5, which occurs in approximately 0.5% of Slavic subjects, may be associated with an increased risk of breast cancer (BC). We attempted to validate these findings in Russian subjects, who are also of Slavic descent. Heterozygous carriers for the 657del5 mutation were detected in 2 of 173 (1.16%) bilateral breast cancer cases, 5 of 700 (0.71%) unilateral breast cancer patients, 2 of 348 (0.57%) healthy middle-aged females and in 0 of 344 elderly tumor-free women. The difference between the "extreme" cohorts, i.e., biBC patients vs. elderly controls, approached the formal limit of statistic significance (p=0.046). LOH at NBS1 was detected in only 3 of 5 available breast tumors from NBS1 657del5-carriers. In 2 of these tumors, the loss involved the mutant NBS1-allele. Overall, our data suggest that the NBS1 657del5 allele may contribute only to a limited fraction of breast cancer cases in Russia.

A Case of Bilateral Breast Cancer and Graves’ Disease

We report a case of bilateral breast cancer associated with Graves' disease characterized by a large goiter and complicated by a severe ophthalmopathy. The hyperthyroidism was treated initially with methimazole and then with thyroidectomy, the ophthalmopathy with intravenous steroids combined with orbital radiotherapy. The breast tumors underwent surgical resection followed by chemotherapy. We describe this case because of the well-known association between breast cancer and thyroid disease, particularly of the autoimmune type, the causes of this being still unclear. Recent literature on this topic is reviewed, discussing the possible role of the Na(+)-I(-) symporter and anti-TPO antibodies.

Phenotypic similarities in bilateral breast cancer.

Bilateral breast cancers that develop at similar times in an individual are likely to have been subjected to similar hormonal, environmental and genetic influences during tumourogenesis compared with metachronous tumours. As such, it is possible that tumour phenotype in synchronous bilateral breast cancer may display similar biological characteristics. The aim of this study was to identify phenotypic similarities between synchronous and metachronous bilateral breast cancers which may suggest a common origin. Thirty-three cases of synchronous and 46 cases of metachronous bilateral breast cancer that displayed similar tumour type were analysed for concordance in relation to various histological and immunohistochemical parameters. A higher level of concordance was demonstrated for synchronous cases with the highest level seen for oestrogen receptor. It is likely that this is related to similar tumourogenic pathways occurring at equivalent exposure times to various environmental and hormonal influences, although, in a proportion of cases, inherited genetic factors may play a role.

P4 The presence of hereditary BRCA1 gene mutations in women with familial breast cancer or familial ovarian cancer and the frequency of the occurrence of these tumours in their relatives

A few founder BRCA1 mutations (5382insC, 4154delA, 185delAG) account for up to 15% of high-risk (young-onset or familial or bilateral) breast cancer (BC) cases in Russia. The impact of non-founder BRCA1 mutations in this country is less studied; in particular, there are no reports analyzing gross rearrangements of this gene in the Russian patient series. We selected for the study 95 founder mutation negative high-risk BC cases. Combination of high-resolution melting (HRM) and sequencing revealed six presumably BC-associated alleles (2080delA, 4808C > G, 5214C > T, 5236G > A, 5460G > T, 5622C > T) and one variant of an unknown significance (4885G > A). The pathogenic role of the 5236G > A mutation leading to G1706E substitution was further confirmed by the loss of heterozygosity analysis of the corresponding tumor tissue. Multiplex ligation-dependent probe amplification (MLPA) revealed two additional BRCA1 heterozygotes, which carried BRCA1 deletions involving exons 1–2 and 3–7, respectively. Based on the results of this investigation and the review of prior Russian studies, three BRCA1 mutations (2080delA, 3819del5, 3875del4) were considered with respect to their possible founder effect and tested in the additional series of 210 high-risk BC patients; two BRCA heterozygotes (2080delA and 3819del5) were revealed. We conclude that the non-founder mutations constitute the minority of BRCA1 defects in Russia.

Cancer du sein bilatéral. Incidence et facteurs de risque

Objective. – To clarify, thanks to a retrospective study of 24 bilateral breast cancer cases, the frequency, the risk factors and the prognosis of bilateral breast cancers. Patients and method. – Between 1984 and 1999, out of 506 patients treated for unilateral non-metastatic breast cancer at Gynecologic and Obstetric ward, at Maternity Souissi of Rabat, 24 cases of bilateral breast cancers were diagnosed. Our results were compared to those of the literature. Results. – The frequency of bilateral breast cancers was 4.7% (24/506). In 87.5% of cases, these were metachronous cancers with a mean interval of 45 months (12–144 months). Patients under 40 at first cancer ran a fivefold superior risk than women more than 40 ( P < 0.05). In cases of T3 or T4 tumors, the risk was 10-fold superior to that in smaller ones ( P < 0.05). Discussion and conclusion. – Significantly more first metachronous tumors were invasive adenocarcinoma cancers. Histologic type of first and second tumor was the same in all cases. The prognosis depends at once on the first and second cancer staging and the treatment must be done according to the same rules as in the first cancer.

Molecular cytogenetic investigations of synchronous bilateral breast cancer

Background: Bilaterality in breast cancer is a rare event and together with an early onset of disease points towards inheritance of the disease. However, most cases seem to occur sporadically,...