Cases Of Intraductal Carcinoma Research Articles

Low-grade Apocrine Intraductal Carcinoma: Expanding the Morphologic and Molecular Spectrum of an Enigmatic Salivary Gland Tumor.

Intraductal carcinoma (IDC) is the current designation for a salivary gland neoplasm previously referred to as "low-grade salivary duct carcinoma" and "low-grade cribriform cystadenocarcinoma," among others. IDC is conceptually believed to be similar to ductal carcinoma in-situ of the breast. Although IDC is one entity in the current WHO Classification of Head and Neck Tumors, recent studies have suggested that at least three subtypes exist: a low-grade, intercalated duct-like variant with frequent RET rearrangements; a high-grade apocrine variant with complex, salivary duct carcinoma-like genetics; and a mixed variant. We sought to characterize an unusual form of low-grade, purely apocrine IDC. Three cases of apocrine-type IDC with low-grade histology were retrieved from the authors' consultation files. Immunohistochemistry for androgen receptor, GCDFP-15, S100, smooth muscle actin, and p40 was performed. A custom, targeted next generation sequencing (NGS) panel including 1425 cancer-related genes was also done on all cases. All three cases developed in the parotid glands of men, aged 51, 63, and 73years (mean, 62years). All cases consisted of large, rounded macrocysts surrounded by smaller nests which were lined by cells with abundant granular eosinophilic cytoplasm and large round nuclei with prominent nucleoli. Pleomorphism was mild, the mitotic rate was low, and necrosis was absent. No cases had any invasive foci or areas of intercalated duct-like morphology. By immunohistochemistry, all cases were diffusely positive for androgen receptor and GCDFP-15, surrounded entirely by an intact layer of small myoepithelial cells positive for S100, smooth muscle actin, and p40. Targeted NGS results were obtained from two cases: both harbored HRAS mutations and copy number losses in TP53, while one case each harbored mutations in PIK3CA, SPEN, and ATM. Fusions were absent in both cases. All three patients were treated by surgery alone, and are currently free of disease (follow up 12-190months). This study confirms the existence of a low-grade, purely apocrine form of IDC. In its pure form, i.e., without an intercalated duct-type component, low-grade apocrine IDC is genetically similar to high-grade salivary duct carcinoma, with frequent HRAS and PI3K pathway mutations. Despite its molecular similarities to the aggressive salivary duct carcinoma, low-grade apocrine IDC appears to behave in a very indolent manner, supporting is classification as a non-invasive neoplasm, and underscoring the need to distinguish these tumors from each other.

Application of contralateral mastoplasty in breast reconstruction after breast cancer surgery

To introduce a contralateral mastoplasty in breast reconstruction with prosthesis after breast cancer surgery in order to gain bilateral breasts symmetry. Between January 2016 and June 2018, 11 female patients with breast cancer were treated, aged 34-64 years old (mean, 49.6 years). There were 5 cases in left side and 6 cases in right side. There were 3 cases of invasive carcinoma and 8 cases of intraductal carcinoma. The diameter of tumor was 0.2-4.1 cm (mean, 2.5 cm). The disease duration ranged from 1 to 15 months (mean, 6 months). According to Regnault grading criteria, there were 7 cases of mild breast ptosis and 4 cases of moderate breast ptosis. Simple nipple-sparing mastectomy and reconstruction using prosthesis of the affected side, and folding and lifting of the nipple-areolar complex of the healthy side were performed. The operation time was 144-188 minutes (mean, 158 minutes). The hospital stay was 6-9 days (mean, 7.5 days). Postoperatively, poor incision healing occurred in 1 case and healed after symptomatic treatment. The other incisions healed well and no surgical-related complications occurred. All patients were followed up 6-30 months (mean, 16 months). At 3 months after operation, the expert group adopted the self-made rating scale to evaluate the bilateral breasts symmetry, and the score was 8-10 (mean, 8.9). The patients were evaluated for their satisfaction according to the self-made score scale, and the score was 8-10 (mean, 9.1). After immediate breat reconstruction with prosthesis after breast cancer surgery, the satisfied bilateral breasts appearances and symmetry can be obtained by contralateral mastoplasty.

Abstract P2-01-29: Axillary involvement in lobular breast cancer

Abstract Purpose: Since the beginning of the use of the technique of selective sentinel node biopsy (SLNB), multiple models have been proposed to predict both the probability of involvement of the sentinel lymoh node (SLN), and, in case it is positive, the likelihood of non-sentinel lymph node (NSLN) involvement. Some of the factors that increase the likelihood of SN involvement (multifocallity, hormonal receptors, larger size…)are frequently found in invasive lobular carcinoma. Invasive lobular carcinoma (ILC) is the second most common histologic type of invasive mammary carcinoma, comprising 5%– 15% of all invasive breast carcinomas. However, in recent decades an increase in the relative incidence of this variant has been reported in the literature. This has been linked to the employment of hormone replacement therapy, the use of assisted reproduction techniques (IVF) or greater availability of diagnostic tools such as breast ultrasound or MRI that allow their better detection. The aim of this study is to determine the extent of axillary involvement in both SLN and NSLN in patients with ILC Patients and Methods 369 cases of infiltrating carcinoma candidates for SLNB technique between April 2010 and April 2013 were reviewed retrospectively. Patients must have a diagnosis of breast cancer of any histological type, with a screening ultrasound without clinical suspicion of axillary involvement. Cases of intraductal carcinoma that underwent SLNB were excluded and even those that were performed prior to neoadjuvant treatment Data on age, histological type, positivity / negativity of the SLN, implementation or not of axillary lymphadenectomy and outcome of involvement of NSLN were collected. Statistical calculations were performed with SPSS. Results Of the 369 selected patients, 291 (79.9%) had invasive ductal carcinoma (IDC), 55 (15.1%) ILC and 18 other histological types (mucinous, colloid, tubular, papillary or mixed). The median age was 58.6 years. SLN could not be found in 5 patientes. 225 (61.8%) had a negative SLN. In 139 (38.2%) patients, SLN was positive, 64 of these cases showed micrometastasis while 75 presented macrometastasis. Among IDC, 108 (37.1%) of the cases had a positive SLN, 53 (49.1%) of them with macrometastases. Among ILC, 27 (49.1%) of the cases presented positive SLN, in 20 of them (74.1%) with macrometastasis. Differences in both the SLN involvement and the presence of macrometastases observed between IDC and ILC were statistically significant (p< 0.001). In those cases were a lymph node dissection was performed, the probability of finding NSLN affection was 18.8% in the case of IDC compared to 55% in patients with ILC (p< 0.001). Conclusions Axillary lymph node involvement in the case of candidates for SLNB is more frequent and more extensive in patients with ILC than in patients with IDC. Citation Format: Pilar Zamora, Covadonga Marti, Ana Roman, Jose M Oliver, Javier de Santiago, Jose I Sanchez-Mendez. Axillary involvement in lobular breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-01-29.

Intraductal Carcinoma of the Prostate Without Invasive Carcinoma on Needle Biopsy: Emphasis on Radical Prostatectomy Findings

Limited information is available on radical prostatectomy findings in men with intraductal carcinoma of the prostate on needle core biopsy in the absence of invasive prostate cancer. From the consulting files of one of us we identified 83 men in whom biopsy showed only intraductal prostate cancer. Followup was available in 66 cases. We reviewed slides in 21 radical prostatectomy cases. Treatment was radical prostatectomy in 23 men, radiation therapy in 15, hormone therapy in 8 and radiation plus hormone therapy in 15 while 5 underwent no treatment or repeat biopsy. Of the 21 radical prostatectomies available for review findings revealed pathological stage pT3a in 8 (38%), pT3b in 3 (13%), pT2 in 8 (38%) and intraductal carcinoma without identifiable invasive cancer in 2 (10%). One patient with pT3a had a positive lymph node at surgery. Average Gleason score was 7.9. Three patients (14%) experienced post-prostatectomy biochemical failure and another (5%) had bone metastases 2.5 years after prostatectomy. In 15 prostatectomies (71%) there was extensive intraductal carcinoma, defined as greater than 10% of tumor being intraductal, including the 2 cases of intraductal carcinoma only. Of the 19 prostatectomies with invasive adenocarcinoma 16 (84%) were conventional acinar adenocarcinoma, 2 (11%) ductal adenocarcinoma, and 1 (5%) mixed ductal and acinar adenocarcinoma. At radical prostatectomy men in whom prior biopsies showed only intraductal carcinoma of the prostate typically have high grade (Gleason score 7 or greater) invasive adenocarcinoma and most have advanced stage disease (pT3). Definitive therapy is recommended in men with intraductal carcinoma of the prostate on needle biopsy even in the absence of pathologically documented invasive prostate cancer.

Idade como fator independente de prognóstico no câncer de mama

to compare the epidemiologic and clinical characteristics, and the follow-up of breast cancer in women diagnosed under and over 40 years of age. a retrospective study, case-control type, with analysis of information obtained from medical records of patients attended from January 1994 to June 2004. Cases of intraductal carcinoma and at stage IV were excluded. Three groups were formed: patients under 40 years old at the diagnosis (n=72); patients between 40 and 50 (n=68) and patients over 50 (n=75). Data about age at the moment of diagnosis, lesion largest diameter, clinical stage, type, histological grade, presence of hormonal receptors and state of the lymph nodes were collected and analyzed. The chi2 test was used for qualitative variables. For quantitative variables without normal distribution (such as number of axillary nodes with metastasis and follow-up duration), the Kruskal-Wallis' test was used. For delineating the curves of free-of-disease and global survival, the log-rank test was used. there was no difference among the groups in the stage distribution, concerning the tumoral differentiation grade or in the distribution of histological types, and in the estrogen receptor and c-erb-B2 expression. Difference was found in the RP expression, which was less frequent in the group of patients under 40, than in the group of patients over 50 (36.2% versus 58.4%) respectively. There was no difference among the groups in the mean tumoral diameter (5.1, 4.7 and 5 cm, respectively). There was also no difference among the groups, concerning the rate of axillary lymph node metastasis (63.9, 46.9 and 50%, respectively). The average follow-up was 54 months for all the groups. Disease recurrence occurred in 22.6% of patients under 40 years old, in 60% of patients between 40 and 50, and in 22.6% of patients over 50, with a significant difference among groups (p<0.0001). Death caused by the disease was higher among patients under 40 (46.9%) than among patients between 40 and 50 (26.9%) and over 50 (22.6%), p=0.0019. The logistic analysis showed that 'age under 40' and the 'presence of more than one metastatic axillary node' were independent death risk factors. age under 40 is an independent risk factor for breast cancer. The traditional prognostic indicators, such as stage, tumoral diameter, axillary involvement and presence of hormonal receptors are not associated with the disease evolution.

What is the predictor for invasion in non-palpable breast cancer with microcalcifications?

To assess the presence of invasion in non-palpable breast cancer with microcalcifications. We investigated 157 patients with non-palpable breast cancer with microcalcifications, who had undergone stereotactic core biopsy or vacuum-assisted breast biopsy and operation at the Cancer Institute Hospital between 1995 and 2001. We investigated the correlation between the area of calcification (maximum range of microcalcifications measured in mm by direct mammography), morphology of calcification on mammography, histological subtype of intraductal carcinoma (comedo or non-comedo) and frequency of invasion, and lymph node metastasis. The chi-square test was used in the statistical analysis and p values less than 0.05 were considered statistically significant. Invasion was observed in 33 of 157 pts (21%), of whom 23 showed minimal invasion, which is less than 0.5 cm in greatest diameter. The risk of invasion was 13% within 10 mm of the microcalcifications (n =70), 25% from 11 to 30 mm (n =59), and 32% more than 31 mm from the microcalcifications (n =28). The risk of invasion was 16% for punctate-round and amorphous type (n =87) microcalcifications, and 27% for pleomorphic and linear-branching types (n =70)(p =0.092). In addition, invasion was found 10% of the time within 10 mm of punctate-round and amorphous type microcalcifications, and 20% of the time at 11 mm or more. On the other hand, invasion was found 15% of the time within 10 mm of pleomorphic and linear-branching type microcalcifications, and 37% of the time at 11 mm or more. In 72 cases of intraductal carcinoma diagnosed by pathological examination, invasion was found in 10 of 31 (32%) comedo type intraductal carcinomas and in 5 of 41 (12%) non-comedo types (p =0.0379). There were 5 cases (3.2%) with axillary lymph node metastasis, all of which widely extended more than 21 mm from the microcalcifications. The risk of invasion was 10% within 10 mm of punctate-round and amorphous type microcalcifications, and 37% at more than 11 mm of pleomorphic, linear-branching microcalcifications.

Use of an artificial neural network to quantitate risk of malignancy for abnormal mammograms

<h2>Abstract</h2> <b>Background.</b> The purpose of this study was to develop a simplified method for standardized categorization of patients with abnormal mammograms by incorporating quantitative risk assessment. <b>Methods and patients.</b> A prospective collection of 1288 outpatient referrals to a surgeon for abnormal mammograms, 185 (14.4%) with malignancy, was studied. Artificial neural network (ANN) and logistic regression (LR) models were developed and compared with the surgeon's clinical impression. The first 490 patients were used as the training set for each model. The ANN and LR were tested on the remaining patients, who were divided into 2 consecutive groups. The main outcome measures were (1) the accuracy (receiver operating characteristic [ROC] curve analysis) of biopsy recommendations based on the surgeon's impression and created by the 2 models and (2) the percentage of cancers that were falsely categorized as benign by the surgeon or the 2 models. <b>Results.</b> Despite the fact that the surgeon's clinical impression showed good discrimination (area under ROC=0.86), 13 of 708 cases (1.8%) thought to be benign by the surgeon proved to be carcinomas. The neural network (but not the LR model) was statistically superior to the surgeon's impression (ANN: ROC=0.89, <i>P</i> = .004; LR: ROC=0.86). Additionally, the computerized models were able to quantitate risk. Those patients predicted to be "benign" by the network (n = 391) had only a 0.5% risk of intraductal carcinoma and no invasive carcinoma, whereas 47% of those patients in the highest risk quartile had cancer. Both computerized models predicted a need for biopsy in 11 of 13 of the lesions (85%) missed by the surgeon's impression. Each model missed only 2 cases of intraductal carcinoma in young women. <b>Conclusions.</b> Computerized risk stratification models, used in routine practice, may help surgeons with decision making. The use of either model helps quantitate risk, thereby facilitating discussions with patients, and may reduce the number of "missed" cancers. (Surgery 2001;129:459-66.)

Use of an artificial neural network to quantitate risk of malignancy for abnormal mammograms

Background. The purpose of this study was to develop a simplified method for standardized categorization of patients with abnormal mammograms by incorporating quantitative risk assessment. Methods and patients. A prospective collection of 1288 outpatient referrals to a surgeon for abnormal mammograms, 185 (14.4%) with malignancy, was studied. Artificial neural network (ANN) and logistic regression (LR) models were developed and compared with the surgeon's clinical impression. The first 490 patients were used as the training set for each model. The ANN and LR were tested on the remaining patients, who were divided into 2 consecutive groups. The main outcome measures were (1) the accuracy (receiver operating characteristic [ROC] curve analysis) of biopsy recommendations based on the surgeon's impression and created by the 2 models and (2) the percentage of cancers that were falsely categorized as benign by the surgeon or the 2 models. Results. Despite the fact that the surgeon's clinical impression showed good discrimination (area under ROC = 0.86), 13 of 708 cases (1.8%) thought to be benign by the surgeon proved to be carcinomas. The neural network (but not the LR model) was statistically superior to the surgeon's impression (ANN: ROC = 0.89, P = .004; LR: ROC = 0.86). Additionally, the computerized models were able to quantitate risk. Those patients predicted to be “benign” by the network (n = 391) had only a 0.5% risk of intraductal carcinoma and no invasive carcinoma, whereas 47% of those patients in the highest risk quartile had cancer. Both computerized models predicted a need for biopsy in 11 of 13 of the lesions (85%) missed by the surgeon's impression. Each model missed only 2 cases of intraductal carcinoma in young women. Conclusions. Computerized risk stratification models, used in routine practice, may help surgeons with decision making. The use of either model helps quantitate risk, thereby facilitating discussions with patients, and may reduce the number of “missed” cancers. (Surgery 2001;129:459-66.)

P53 protein expression and nuclear DNA content in breast intraductal proliferations.

Immunohistochemical analysis of the p53 gene protein and cytometric assessment of nuclear DNA were performed in a series of 51 cases of intraductal breast proliferation. The series included 22 cases of intraductal hyperplasia without atypia, 6 cases of intraductal hyperplasia with atypia, and 23 cases of pure intraductal carcinoma. Expression of p53 protein was detected in one case of intraductal hyperplasia without atypia (4.5 per cent), one case of intraductal hyperplasia with atypia (16.6 per cent) and six cases of intraductal carcinoma (26.0 per cent). No significant correlation was observed between p53 expression and histological subtype of intraductal carcinoma. Aneuploidy was demonstrated in two cases of intraductal hyperplasia with atypia (33.3 per cent) and in 18 cases of intraductal carcinoma (78.2 per cent). All cases of intraductal hyperplasia without atypia were euploid. No significant association was observed between p53 protein expression and ploidy in intraductal hyperplasia. The only case of intraductal hyperplasia without atypia positive for p53 was euploid, whereas the only p53-positive case of intraductal hyperplasia with atypia was aneuploid. Among the intraductal carcinomas, only the aneuploid cases showed positivity for p53, regardless of histological subtype. The results suggest that some of the changes observed in invasive breast carcinoma, such as p53 expression and aneuploidy, are already present in breast intraductal proliferation, especially in areas with atypia and in intraductal carcinoma. The expression of p53 in breast intraductal proliferation may reflect the acquisition of p53 gene mutations in cells unable adequately to repair DNA damage, with genomic instability which would lead to clonal expansion and putative evolution to invasive disease.

Different types of microcalcifications observed in breast pathology. Correlations with histopathological diagnosis and radiological examination of operative specimens.

Microcalcifications taken from 50 systematized mammary excisions were submitted to light microscopic and scanning electron microscope analysis. Microprobe and x-ray diffraction analyses were also performed. Two main types were observed: Type I microcalcifications composed of weddellite crystals. They were observed in benign breast lesions only (11 cases out of 21) or, in lobular carcinomas in situ (L.C.I.S.) of the breast (5 cases out of 6). They were not seen in 3 cases of intraductal carcinoma (I.D.C.) nor in infiltrating (I.C.) carcinomas (20 cases). Type II microcalcifications, non-cristalline in nature, composed of calcium, phosphate, hydroxyapatite or of phosphorus and calcium associated with other elements, were observed in benign lesions (10 cases out of 21) and in all cases of infiltrating carcinomas. The microcalcifications observed on mammography were also found on the radiographs of systematised mammary excisions from the lesion or from its immediate vicinity, but only when using the appropriate technique. Microcalcifications are therefore an excellent marker of breast lesions but they cannot be simply divided into "benign" or "malignant" types. Nevertheless, the presence of a visible crystalline structure on the radiograph of the specimen argues in favour of a benign breast lesion or of a lobular carcinoma in situ.