Intraductal Carcinoma Of Breast Research Articles

Synchronous intrahepatic cholangiocarcinoma and intraductal breast carcinoma. A rare case report and literature review

Synchronous intrahepatic cholangiocarcinoma and intraductal breast carcinoma. A rare case report and literature review

Intraductal papillary carcinoma of breast with invasion: A nomogram and survival from the analysis of the SEER database.

Intraductal papillary carcinoma (IPC) with invasion is a rare type of breast cancer. There have been few studies on its prognosis, and a nomogram that predicts the prognosis of the disease has not been described to date. Patients who were diagnosed with invasive IPC were screened from the Surveillance, Epidemiology, and End Results (SEER) database. The screened patients were randomly divided into a training cohort and a verification cohort at 7:3. A Cox proportional hazard regression model was performed to analyze the effects of different variables on the risk of death in invasive IPC. A nomogram was constructed to quantify the possibility of death. The concordance index (C-index), calibration plots, receiver operating characteristic (ROC) curves, and decision curves analysis (DCA) were used to verify the proposed model. We included a total of 803 patients diagnosed with invasive IPC, including 563 patients in the training cohort and 240 patients in the validation cohort. The median follow-up times in the training cohort and validation cohort were 63 months (range, 2-155 months) and 61 months (range, 1-154 months), respectively. For all patients, the probability of death with invasive IPC was 1.4% within 5 years and 5.4% within 10 years. In multivariate analysis, sex, race, tumor size, lymph node status, type of treatment, and chemotherapy were related to the prognosis of invasive IPC. We constructed a nomogram to predict the possibility of death in patients with invasive IPC. Patients with invasive IPC had a high survival rate. The proven nomogram was helpful to both patients and clinical decision makers.

Cyclin D1 as emerging biomarker and its correlation with other biomarkers in intraductal carcinoma of breast

Cyclin D1 as a biomarker is over expressed in indraductal carcinoma in breast not in benign breast diseases.The study has been conducted in the Department of Pathology of a tertiary medical college of eastern India (n=57, d=18 months).The primary aim was to find the correlation between Cyclin D1 with different biomarkers as well as other variables.The association of age, ER (Estrogen Receptor) scoring, ER Positive & Negative status, PR scoring, PR positive and negative status, Her2Neu status, Tumor grade, Stage of the tumour, Laterality and location vs group have not been found to be statistically significant. However association of Her2Neu scoring (p=0.03), Ki67 status (p=0.002), Molecular Classification (p=0.01) vs group has been found to be statistically highly significant.Cyclin D1 over expression has been reported in about half of the human breast cancers and the present study has found its direct relationship of Her2Neu scoring, Ki67 labelling index status and molecular classification vs group enriching our present knowledge and understanding.

Histopathological and Immunohistochemical Studies of A Typical Case of Intraductal Papillary Carcinoma of A Male Breast

Intraductal papillary carcinoma is very uncommon breast disease, constituting 0.5% to 1% of all breast cancers. Intraductal and intracystic papillary carcinomas are the histological classification of papillary carcinomas. Here we report, a 61 year old man presented with a mass in the upper outer quadrant of the left breast, with associated nipple discharge and bleeding since 2 months. Histological examination revealed tumor cells arranged in multi-cell layered papillae mostly in dilated lumen with foci of cribriform, follicular and solid pattern. Occasional psammoma bodies are also noted. Surgical excision is usually recommended after core-needle biopsy if there is atypia, high risk lesion, imaging histological discordance or positivity for malignancy. Often biopsy excision is performed directly when papillary carcinoma is suggested by sonography or mammography. Indeed, the surgical excision allows the pathologist to classify the papillary by classically histological examination of the lesions especially with immunohistochemical study and to research invasion or DCIS in surrounding breast tissue, present in majority of cases. There are no evidence based guidelines for treatment of intraductal papillary carcinoma. Hence, it is recommended to go for conservative surgery without axillary dissection, which shows excellent prognosis.

Modified radical mastectomy for intraductal breast carcinoma in a patient with active pulmonary tuberculosis under thoracic epidural anaesthesia

The incidence of breast carcinoma is on the rise in Asian countries like India and pulmonary tuberculosis is one of the most common infectious diseases encountered here. Although coexistence of active pulmonary tuberculosis and breast cancer in same patient is rare, it poses a huge challenge to the anaesthetist when patients having the above conditions concomitantly are posted for surgeries like mastectomy. Here we report the anaesthetic management of a case of breast carcinoma with active pulmonary tuberculosis managed successfully under thoracic epidural anaesthesia chosen to avoid major hemodynamic, respiratory and other complications like operation theatre pollution and drug interactions between anti tubercular and anticancer drugs and drugs used for general anesthesia.

Abstract P2-02-21: Longitudinal analysis of circulating tumor cells and cell free tumor DNA by next generation sequencing in triple negative breast cancer

Abstract As the practice of genetically profiling patient tumors is considered for making clinical treatment decisions, recent methodologies for screening of genomic aberrations in circulating tumor cells (CTCs) and cell-free plasma DNA (cfDNA) may provide non-invasive tools for such applications. Genomic analysis of DNA from CTCs and plasma can also provide useful insight into tumor heterogeneity and thus disease progression by revealing sub-populations of tumor cells that evolve during treatment, have novel drug-resistant genotypes, or carry alternate cancer driver mutations not identified by the sequencing of primary tumors. Comprehensive evaluation of DNA isolated from CTCs and cfDNA from a breast cancer patient by whole exome sequencing was performed to better understand the role of liquid biopsies in investigating the etiology of tumor progression. The patient was diagnosed with metastatic triple negative breast cancer (TNBC) six years after remission from estrogen receptor (ER-3+), progesterone receptor (PR-1+), human epidermal receptor growth factor 2 negative (Her2-), grade 3 intra-ductal carcinoma of the right breast. Metastatic lesions were found in the spine, pelvis and sacrum and bone-marrow. The patient was enrolled in the Intensive Trial of OMics in Cancer clinical Trial (ITOMIC-001; ClinicalTrials.gov ID NCT01957514) and initially received weekly cisplatin infusions followed by additional targeted therapy. Peripheral blood was obtained during regular clinic visits over the 272 days the patient was enrolled in the clinical trial. CTCs were identified and enumerated from each blood draw using the AccuCyte® -CyteFinder® (AC/CF) system (RareCyte, Seattle WA). Multiple CTCs along with white blood cells (WBCs) were picked from various time points throughout the treatment regimen. The selected CTCs and WBCs were whole genome amplified and whole exome sequencing was performed to identify tumor specific variants. A comparative analysis with variants present in genomic DNA isolated from the bone-marrow metastasis tissue biopsy samples and cfDNA revealed the evolution of tumor-specific variants during therapy. Each CTC had somatic alterations in genes associated with therapies in current use or those in the clinical trials setting. Sequencing analysis of cfDNA provided similar information on potential therapeutic approaches. The monitoring of disease over time through genomic analysis of CTCs and cfDNA can identify novel sub-populations related to disease progression for the tailoring of cancer treatment regimens. Further analysis is being performed to better understand the evolution of the genomic heterogeneity among CTCs at the same time point and across different time points and therefore better understand the etiology of progression of metastatic breast cancer in this patient. Citation Format: Howard K, Austin S, Ramirez AB, Ritter L, Boles D, Pruitt J, Collins H, Mahen E, Leonti A, Maassel L, Subia C, Tuuli S, Heying N, Deutsch K, Cox J, Lo FY, Stilwell JL, Kaldjian EP, Dorschner M, Blau S, Blau A, Eisenberg M, Anderson S, Madan A. Longitudinal analysis of circulating tumor cells and cell free tumor DNA by next generation sequencing in triple negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-02-21.

Synchronous quadruple multiple primary cancers of the tongue, bilateral breasts, and kidney in a female patient with a disease-free survival time of more than 5 years: a case report.

BackgroundReports of synchronous multiple primary cancers in patients with oral cancer have recently been increasing because of progress in radiographic diagnostic techniques. Multiple primary cancers in patients with oral cavity cancer mainly occur in the head and neck region, lung, and esophagus. 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography is usually used to identify synchronous multiple primary cancers.Case presentationWe herein describe a 69-year-old woman diagnosed with synchronous quadruple multiple primary cancers, namely a squamous cell carcinoma of the mobile tongue, invasive ductal carcinoma of the right breast, intraductal carcinoma of the left breast, and chromophobe renal cell carcinoma of the right kidney. We removed the four tumors over three surgical procedures to reduce the surgical risk because the patient had diabetes mellitus. To the best of our knowledge, this combination of multiple primary cancers has not been reported to date. Importantly, we followed this case for 5 years after surgery. The patient was alive and well with no clinical or radiologic signs of recurrent or metastatic disease at the time of this writing.ConclusionsIn the present case, the kidney cancer could not be detected by 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography but could be detected by contrast-enhanced computed tomography. To avoid overlooking multiple primary cancers of the kidney, we suggest that contrast-enhanced computed tomography should cover a region extending to the inferior margin of the kidney, rather than only to the liver, in patients with oral cavity cancer.

Paraneoplastic cerebellar degeneration and dermatomyositis as first manifestations of underlying breast malignancy: a report of two cases and a brief review of the subject

Paraneoplastic syndromes are rare first manifestations of breast cancer. In this report, we present two cases of a 58-year-old woman and a 69-year-old woman presenting with acute symptoms of paraneoplastic cerebellar degeneration (PCD) and dermatomyositis, respectively, as the first sign of breast malignancy. The patient diagnosed with PCD presented initially with ataxia, was serum anti-Yo antibody negative, and subsequently investigated to have poorly differentiated intraductal breast carcinoma. Cerebellar symptoms regressed following breast cancer surgery and chemotherapy, highlighting the better neurological prognosis associated with anti-Yo antibody negative PCD. The rarity of these presentations highlights the necessity to include an occult malignancy in the differential diagnosis when attending to such patients.

Metaplastic breast cancer : Pathological subtypes, clinical presentation, imaging characteristics, Immunohistochemistry, treatment and prognosis

Metaplastic breast cancer is a rare subtype of breast cancer that is histologically heterogeneous, being composed of both sarcomatous and epithelial components. It presents as rapidly growing palpable masses. Incidence of nodal metastasis is low, as compared to intraductal carcinoma, but it has a high metastatic potential and more chances of local recurrence. Many different pathological classifications are available, the most popular being Wargotz and Norris classification. Imaging features mimic those of intraductal carcinoma. Immunohistochemically, these tumors show a basal/myoepithelial phenotype with positivity for cytokeratins, AE1/AE3, smooth muscle actin, p63, alpha B-crystallin, etc. These tumors show no or very low positivity for hormone receptors or HER-2 over expression. Therefore, they are often called triple negative carcinomas. They are aggressive tumors with suboptimal response to standard chemotherapy regimens. Overall prognosis of the patients with metaplastic breast cancer is worse than the patients with intraductal breast carcinoma. Further research is needed for formulating targeted therapies for this aggressive tumor.

Recurrent tetanus in diagnosed breast cancer patients of the Philippine General Hospital

This is the first report of recurrent tetanus in two cases of breast cancer. The first case is of a 40-year old female with intraductal carcinoma of the right breast who was admitted for tetanus with breast mass ulcers as presumptive focus. She was given anti-/INS;tetanus vaccines and appropriate antibiotics. No wound debridement was done for fear of tumor seeding. She was discharged clinically cured of tetanus. Despite adequate treatment, the patient had recurrence of the tetanus 40 days after discharge. The second case is of a 56-year old female diagnosed with intraductal carcinoma of the left breast who developed tetanus after accidentally injuring the breast mass with a door nail. Similarly, she was given anti-/INS;tetanus vaccines and appropriate antibiotics. There was no consent to any intervention on the breast mass. She was discharged cured, but returned after 32 days with recurrent tetanus. The recurrence of tetanus in these patients could be due to incomplete elimination of the infection, presence of chronic wound, and inability to mount sufficient immunity. Tetanus is a preventable and treatable condition with high mortality. Gathering of local data on recurrent tetanus and vaccine efficacy may be subject of future studies. It is recommended that guidelines on the management of tetanus specifically in immunocompromised patients with untreated chronic wounds as well as policies on routine vaccination of cancer patients be formed.

Low-Grade Salivary Duct Carcinoma or Low-Grade Intraductal Carcinoma? Review of the Literature

Low-grade salivary duct carcinoma (LG-SDC) is a rare neoplasm characterized by predominant intraductal growth, luminal ductal phenotype, bland microscopic features, and favorable clinical behavior with an appearance reminiscent of florid to atypical ductal hyperplasia to low grade intraductal breast carcinoma. LG-SDC is composed of multiple cysts, cribriform architecture with "Roman Bridges", "pseudocribriform" proliferations with floppy fenestrations or irregular slits, micropapillae with epithelial tufts, fibrovascular cores, and solid areas. Most of the tumor cells are small to medium sized with pale eosinophilic cytoplasm, and round to oval nuclei, which may contain finely dispersed or dark condensed chromatin. Foci of intermediate to high grade atypia, and invasive carcinoma or micro-invasion have been reported in up to 23 % of cases. The neoplastic cells have a ductal phenotype with coexpression of keratins and S100 protein and are surrounded by a layer of myoepithelial cells in non-invasive cases. The main differential diagnosis of LG-SDC includes cystadenoma, cystadenocarcinoma, sclerosing polycystic adenosis, salivary duct carcinoma in situ/high-grade intraductal carcinoma, and papillary-cystic variant of acinic cell carcinoma. There is no published data supporting the continuous classification of LG-SDC as a variant of cystadenocarcinoma. Given that most LG-SDC are non-invasive neoplasms; the terms "cribriform cystadenocarcinoma" and LG-SDC should be replaced by "low-grade intraductal carcinoma" (LG-IDC) of salivary gland or "low-grade intraductal carcinoma with areas of invasive carcinoma" in those cases with evidence of invasive carcinoma.

Hiperplasia estromal pseudoangiomatosa de la mama (HEPA): estudio clínico, radiológico y patológico de 4 casos

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion, characterized by a benign overgrowth of fibrous connective tissue of the breast, which produces numerous spaces resembling vascular structures. This entity most commonly affects premenopausal women but cases have been described at all ages ranging from 12 to 75 years. PASH is usually an incidental histological finding after surgery for benign or malignant tumors but may also present as a mass or painless nodule mimicking fibroadenoma. Ultrasound-guided percutaneous biopsy allows the type of lesion to be determined and malignancies, such as low-grade angiosarcoma, to be excluded. We report four new cases of PASH with distinct clinical presentations. The first two cases presented as a single painless breast mass, the third as an incidental finding in the surgical specimen from a quadrantectomy performed for an intraductal breast carcinoma, and the fourth case occurred in a man with unilateral gynecomastia.

The expression of Snail mRNA and E-cadherin mRNA in breast cancer and their clinical significance

Objective To investigate the expressions of Snail mRNA and E-cad mRNA in invasive ductal carcinoma and their clinical significance. Methods The expression of Snail mRNA and E-cad mRNA were detected on mammary gland hyperplasia (30cases), intraductal breast carcinoma(30cases) and invasive ductal carcinoma (70cases)by in situ hybridization. Results The positive expression rate of Snail mRNA and E-cad mRNA in mammary gland hyperplasia, intraductal breast carcinoma and invasive ductal carcinoma were 23. 3% ,46. 7% ,81.4% and 96. 7% ,66. 7% ,35.7% ,respectively. There was significant difference among them(P ＜ 0. 01). There was difference between Snail mRNA and E-cad mRNA in the same group(P ＜0. 05). Snail mRNA was not related to age, tumor size or histopathological grade (P ＞0. 05) ,but it was related to lymphatic metastasis (P ＜0. 01). E-cad mRNA was not related to age, tumor size(P ＞0. 05),but it was related to lymphatic metastasis and histopathological grade(P ＜0. 01). There were positive relationship between Snail mRNA and E-cad mRNA(r = -0. 56, P =0. 00). Conclusions The overexpression of Snail mRNA and low expression of E-cad mRNA were involved in the infiltration and metastasis of breast carcinoma, and they were related to lymphatic metastasis. Therefore, the test of the expression of them were valuable in predicting the prognostic and metastasis of breast carcinoma. Key words: Cadherins/BI; Transcription factors/BI; Breast neoplasms/ME

Microdochectomy in the management of pathologic nipple discharge

There is a debate in the literature whether a pathologic nipple discharge is a distinct sign of breast carcinoma. Our own results obtained by the use of microdochectomy as a minimally invasive operative procedure in 184 patients with pathologic nipple discharge were analysed. The aim of this retrospective 20-year study was to assess the efficacy of microdochectomy in detecting early stages of intraductal breast carcinoma. The study included data on 184 patients aged 24-77 years (median 46.6) divided into two groups of premenopausal (n = 123) and postmenopausal (n = 61) women. There were 139 patients with unilateral single-duct sanguinolent discharge and 45 patients with other types of nipple discharge. The operative procedure consisted of the discharging duct excision by use of a guide probe, preceded by cytology and ductography studies. Histopathology of the excised ducts revealed only three carcinomas in premenopausal women and ten carcinomas in postmenopausal women. In a total of 13 carcinomas, there were 4 ductal carcinomas in situ, detected in patients aged 41-72 (median 66) years. Twelve carcinomas were associated with sanguinolent nipple discharge. Papilloma was the most common histology finding (56.5%). Results of the study suggested mainly the association of sanguinolent single-duct nipple discharge and papilloma, whereas the rate of malignancies detected (7.0%) was consistent with literature reports. Microdochectomy proved to be a highly efficient operative method free from any impairment of the breast integrity. Conservative treatment with close clinical monitoring of the patient with cytology and ultrasonographic assessment might be possible in selected cases.

Successful pregnancy outcome with 5-flurouracil, epirubicin, cyclophospamide chemotherapy, and hemostatic radiotherapy with abdominal shielding for metastatic invasive intraductal breast carcinoma

A case of metastatic infiltrating breast cancer in a young multiparous lady with 33 weeks pregnancy is presented who was treated with combination chemotherapy and hemostatic radiotherapy and had successful pregnancy outcome.

Preoperative MRI of pure intraductal breast carcinoma—A valuable adjunct to mammography in assessing cancer extent

The aim of the study was to evaluate the contribution of preoperative breast magnetic resonance imaging (MRM) as an adjunct to mammography in assessing extent of pure ductal carcinoma in situ (DCIS) and to relate magnetic resonance imaging (MRI) findings to histopathological features. A retrospective analysis was conducted of 86 histologically proven cases of pure DCIS of the breast. Two experienced radiologists with knowledge of clinical and histopathological findings at the time of the review evaluated mammographic and preoperative MRI results by consensus. Compared to histopathology, mammography or MRM alone underestimated DCIS extent in 18.6% and 31.4% of cases, respectively. When both imaging modalities were considered, DCIS extent was underestimated in 8% of cases. Combined use of mammography and MRM revealed good agreement with histopathology to assess DCIS extent ( κ=0.439; P<0.001). MR enhancement of DCIS was related to histologic size ( P=0.011). Mammography is more accurate than MRM in assessing cancer extent of pure DCIS, but combined use of both imaging techniques leads to improved accuracy.

Surrounding ipsilateral eruptive seborrheic keratosis as a warning sign of intraductal breast carcinoma and Paget's disease (Leser Trelat sign)

Paget disease of the breast, most often occurs in middle-aged women. Leser-Trelat sign is a rare cutaneous manifestation of internal malignancy that is usually associated with visceral-type adenocarcinoma. We report a patient with Paget disease of the nipple and intraductal carcinoma who presented with ipsilateral, eruptive grouped seborrheic keratoses of the areola and nipple of the breast.

Expression and significance of CD44s, CD44v6, and nm23 mRNA in human cancer

To investigate the relationship between the expression levels of nm23 mRNA, CD44s, and CD44v6, and oncogenesis, development and metastasis of human gastric adenocarcinoma, colorectal adenocarcinoma, intraductal carcinoma of breast, and lung cancer. Using tissue microarray by immuhistochemical (IHC) staining and in situ hybridization (ISH), we examined the expression levels of nm23 mRNA, CD44s, and CD44v6 in 62 specimens of human gastric adenocarcinoma and 62 specimens of colorectal adenocarcinoma; the expression of CD44s and CD44v6 in 120 specimens of intraductal carcinoma of breast and 20 specimens of normal breast tissue; the expression of nm23 mRNA in 72 specimens of human lung cancer and 23 specimens of normal tissue adjacent to cancer. The expression of nm23 mRNA in the tissues of gastric and colorectal adenocarcinoma was not significantly different from that in the normal tissues adjacent to cancer (P>0.05), and was not associated with the invasion of tumor and the pathology grade of adenocarcinoma (P>0.05). However, the expression of nm23 mRNA was correlated negatively to the lymph node metastasis of gastric and colorectal adenocarcinoma (r = -0.49, P<0.01; r = -4.93, P<0.01). The expression of CD44s in the tissues of gastric and colorectal adenocarcinoma was significantly different from that in the normal tissues adjacent to cancer (P<0.05; P<0.01). CD44v6 was expressed in the tissues of gastric and colorectal adenocarcinoma only, the expression of CD44v6 was significantly associated with the lymph node metastasis, invasion and pathological grade of the tumor (r = 0.47, P<0.01; r = 5.04, P<0.01). CD44s and CD44v6 were expressed in intraductal carcinoma of breast, the expression of CD44s and CD44v6 was significantly associated with lymph node metastases and invasion (P<0.01). However, neither of them was expressed in the normal breast tissue. In addition, the expression of CD44v6 was closely related to the degree of cell differentiation of intraductal carcinoma of breast (c2 = 5.68, P<0.05). The expressional level of nm23 mRNA was closely related to the degree of cell differentiation (P<0.05) and lymph node metastasis (P<0.01), but the expression of nm23 gene was not related to sex, age, and type of histological classification (P>0.05). Patients with overexpression of CD44s and CD44v6 and low expression of nm23 mRNA have a higher lymph node metastatic rate and invasion. In addition, overexpression of CD44v6 is closely related to the degree of cell differentiation. Detection of the three genes is able to provide a reliable index to evaluate the invasion and metastasis of tumor cells.

Stage/grade-specific chemo-radiation sensitization of intraductal breast carcinoma cell lines by inhibition of NF-kB

Stage/grade-specific chemo-radiation sensitization of intraductal breast carcinoma cell lines by inhibition of NF-kB

Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women.

Patients diagnosed with ductal carcinoma in situ (DCIS) at a young age appear to have a different natural history and biology, including a higher local relapse rate, than patients diagnosed later in life. The current study compared various pathologic and molecular features of DCIS arising in a cohort of young women with those of DCIS arising in a cohort of older women to identify potential biologic differences between these two populations of patients. The study population consisted of 20 patients age < 42 years and 34 patients age > 60 years who were treated at Yale University School of Medicine with breast-conserving therapy (BCT) and whose archival paraffin blocks were available and had sufficient tumor for staining. The original slides from each case were reviewed and the most representative specimen block from each case was processed for immunohistochemical staining. Pathologic characteristics evaluated for each case included histology, grade, and presence of necrosis. Paraffin-embedded sections were immunohistochemically evaluated for expression of HER-2/neu, estrogen receptor (ER), progesterone receptor (PR), bcl-2, cyclin D1, Ki-67, and p53. Although there was no difference in pathologic features of the tumors between the two groups, HER-2/neu was found to be overexpressed in a greater percentage of the younger population (P = 0.06). There was no apparent difference in expression of the other markers. Of note, HER-2/neu expression was correlated with high nuclear grade (P = 0.004), necrosis (P = 0.06), and ER and PR negativity (P = 0.01 and P = 0.03, respectively) in the combined population. The current study data suggested that HER-2/neu overexpression in younger patients may characterize a biologic difference in their tumor and may partially contribute to their higher risk of recurrence. Further studies are needed to assess whether this difference holds independent of grade and to evaluate the prognostic significance of HER-2/neu overexpression in DCIS.