Right Breast Mass Research Articles

A rare metachronous presentation of periductal stromal sarcoma in a case of recurrent rhabdomyosarcoma – Case report

Periductal stromal sarcoma (PSS) is a an extremely rare low-grade malignant neoplasm arising from breast periductal stroma. It usually occurs in peri and post-menopausal women. Herein, we report a rare case of a 14 year girl, known case of recurrent Rhabdomyosarcoma (RMS) presenting with periductal stromal sarcoma of breast. To the best of our knowledge, this is a first of its kind to be reported in literature. A 14year girl, known case of Recurrent Pleomorphic Rhabdomyosarcoma of retroperitoneum, presented with an abdominal mass and lump in right breast after 10 years. On chemotherapy, abdominal mass regressed and breast lump progressed in size. On further evaluation by histopathological examination and immunohistochemistry, the breast lump turned out to be a periductal stromal sarcoma. Periductal stromal tumors have histological similarities to phyllodes tumors, with the biphasic presence of hypercellular and variably atypical, mitotically active stroma hugging benign epithelium. There are very few case reports on periductal stromal tumors and thus a rare entity. PSS as a metachronous presentation with recurrent RMS is even more rare with the prevalence of multiple soft tissue sarcomas being 0.08%. A clinically suspected metastatic lesion, if accessible for biopsy, warrants a meticulous histopathological examination to ascertain the cell of origin. The therapeutic strategy and prognosis of PSS is unclear, thus a longer follow up is imperative to determine its prognosis and clinical outcome. 2 case reported so far in younger individuals. 1st case of PSS in a Recurrent RMS.

Mucoepidermoid Carcinoma of Breast Presenting as Abscess-like Pus Discharging Mass; A Rare Tumour With Unusual Presentation

Background: Mucoepidermoid carcinoma (MEC) breast is a very rare triple negative breast cancer with relatively better overall prognosis. They have histomorphological and immunohistochemical features similar to the salivary gland MEC. Literature suggests that they also carry molecular characteristics similar to the salivary gland MEC. Case Presentation: A 73-years-old woman presented with complaints of painful, foul smelling pus discharging mass in right breast. Patient underwent therapeutic incision and drainage along with diagnostic biopsy. On histopathology, diagnosis of MEC, high grade was made. Conclusion: Primary MEC is a very rare triple negative breast cancer (TNBC) usually with much better survival outcome in comparison to other TNBCs. However, the index case had locally advanced disease with unique presentation leading to an alternative initial management.

Change from triple negative type to triple positive type: A case report of discordance of re-biopsy from primary breast cancer

The patient was a 60-year-old woman who had visited a clinic with the chief complaint of a mass in the right breast prior to being referred to our hospital. Breast examination revealed the presence of a 3-cm hard elastic mass in the C region of the right breast. Computed tomography (CT) further indicated metastases to the liver and lungs. Upon needle biopsy of the primary tumor, the patient was diagnosed with triple-negative (ER (-), PgR (-), HER2 (-)) invasive lobular carcinoma. Chemotherapy was successful in achieving a transient partial response (PR); however, the tumor later advanced to a progressive disease (PD) after five cycles of oral fluoropyrimidine derivative therapy (S-1). Re-biopsy of the primary tumor revealed that the tumor was triple-positive (ER (+), PgR (+), HER2 (+)). The patient was subsequently treated with anti-HER2 therapy and has since achieved complete response (CR). Although biological changes sometimes occur from the primary to the metastatic tumor, changes in the primary tumor itself during the course of treatment is a rare event. Furthermore, the transition from triple-negative to triple-positive status is very uncommon. Re-biopsy rarely changes the biological characteristics of a tumor; however, biological changes can have a significant impact on treatment if they do occur. Thus, it is important to perform a re-biopsy if the current treatment results in PD.

Progressive Metastatic Breast Phyllodes Tumor Turns into Spindle Cell Sarcoma: Report of Two Cases and Review of the Literature

Background: Breast fibroepithelial lesions encompass a wide variety of tumors from benign fibroadenomas to malignant phyllodes tumors (PTs). Local recurrence was reported in 20% of all subgroups and 20-25% risk of distant metastasis though superaggressive tumors are rare. Two young patients with nonresponsive, frequent recurrences of phyllodes tumors turned into the aggressive metastatic sarcoma are presented.Case Presentation: Case 1: A 34-year-old married woman referred with the chief complaint of a mass and pain in her right breast. There was a 3cm well defined mass in right breast. An intermediate grade benign phyllodes tumor was confirmed in biopsy. Patient underwent surgical wide excision, radiotherapy. Three weeks later the mass recurred in her right breast with severe pain and nonproductive cough without hemoptysis. A single lung metastasis is conformed in the CT scan. Total mastectomy and thoracoscopic metastasectomy was performed and spindle cell sarcomas in both specimens is confirmed. Chemotherapy was done. Two weeks after chemotherapy she presented with multiple bilateral lung metastasises and thoracic wall involvement. No regression in metastasis was seen receiving the second line chemotherapeutic agents. Case 2: A 17-year-old young girl was referred to the breast clinic with a 2 cm firm mobile mass in left breast. The histopathology of the mass was benign phyllodes tumor. (1.5 cm margins) The tumor recurred 3 months later treated. During radiotherapy, the patient referred to the emergency department with the complaint of dyspnea and sever pleural effusion. The cytology reported malignant cells. CT-guided biopsy showed a high grade sarcoma. During chemotherapy, large ulcer in the site of the breast was appeared and mastectomy with Latissmus dorsi flap was performed and angiosarcoma was confirmed. Despite the second and third line chemotherapy the disease was progressed and multiple lung metastasis were confirmed in chest CT scan. Conclusion: It seems that some subtypes of breast sarcomas could have an extremely an aggressive behavior which threatens the life of the patients in a short period of time. Further studies is suggested to discriminate the aggressive subtypes at the first step.

Phyllodes tumor in pregnancy: A Case Report

Phyllodes tumor accounts for less than 1% of all breast neoplasms. These tumors are fast growing masses arising from the periductal stromal cells of the breast. We report a case of phyllodes in a 25 year old primigravida who presented to us at 18 weeks of pregnancy with mass of right breast which appeared 15 days back. She gave history of some mass in right breast for which she was operated 1 year back for which no details or papers were available. On examination there was a tumor in Right breast of about 20x15x11 cm size.ANC examination showed uterus of 18 wks size, FHS 140/min, regular. Patient underwent FNAC and biopsy from the mass which was suggestive of malignant Phyllodes tumor. Patient was prepared for mastectomy and along with surgical team right mastectomy with right axillary lymph node dissection was done. Post-operative period was uneventful. Histopathological examination showed increased cellularity and nuclear atypia suggestive of malignant phyllodes tumour and lymph nodes were negative. We concluded that accurate preoperative pathological diagnosis is very important for management of phyllodes tumor, and allows correct surgical planning and avoidance of reoperation.

Newly Arising Contralateral Granular Cell Tumor after Wide Excision of Large Breast Granular Cell Tumor: A Case Report

Granular cell tumor (GCT) of the breast is a rare neoplasm that is usually benign in nature. The results of physical examination and ultrasonographic findings of GCT of the breast often mimic those of other malignancies. A 46-year-old woman underwent wide excision for removal of a large mass in the left breast (about 10 cm in diameter). The pathologic finding of the excised mass was benign GCT. A year after initial surgery, recurrence of the left breast mass was found along with a newly developed mass in the contralateral right breast, which was excised. In this study, we describe the case of a newly developed GCT in the contralateral breast 1 year after excision of a larger breast GCT. Keywords: Breast; Granular cell tumor; Recurrence

An Adolescent Girl with Giant Fibroadenoma – A Case Report

Though fibroadenoma is the most common benign tumor of the breast and is more common under the age of 30, giant fibroadenoma is rare representing less than 4% of all fibroadenomas. A 12 years old girl presented with rapidly enlarging well-circumscribed firm, non-tender mass in right breast for 2 months which was painless and with no history of trauma, nipple discharge, fever, anorexia, weight loss or axillary lymphadenopathy. There was no family history of neoplasms. Clinically, the lump was about 12 × 12 cm and not fixed to skin or underlying structures with the absence of nipple retraction or discharge. There was no axillary lymphadenopathy. Fine needle aspiration cytology showed a benign proliferative breast disease. Total excision of mass was done preserving nipple and areola having weight of 535 gm with histopathological features suggestive of giant fibroadenoma. Giant fibroadenoma is a benign breast disease that may mimic rare malignant lesion. So, breast and nipple conserving surgery should always be performed irrespective of size of tumor as in this case.

Primary osteogenic sarcoma of breast

A 60-years-old lady presented with a firm to hard mass in right breast. She was investigated with a mammogram and ultrasound which showed a mass of indeterminate nature with extensive calcifications. An ultrasound guided core biopsy of the mass was performed which was reported as a sarcomatous mass and excision biopsy was requested. Excision biopsy concluded that the mass was an osteogenic sarcoma in the background of a phyllodes tumor. Patient underwent a definitive mastectomy two weeks later. Keywords: Primary osteogenic sarcoma; breast cancer; phyllodes tumor

Primary osteogenic sarcoma of breast

A 60-years-old lady presented with a firm to hard mass in right breast. She was investigated with a mammogram and ultrasound which showed a mass of indeterminate nature with extensive calcifications. An ultrasound guided core biopsy of the mass was performed which was reported as a sarcomatous mass and excision biopsy was requested. Excision biopsy concluded that the mass was an osteogenic sarcoma in the background of a phyllodes tumor. Patient underwent a definitive mastectomy two weeks later. Keywords: Primary osteogenic sarcoma; breast cancer; phyllodes tumor

Extensive squamous metaplasia in a benign phyllodes tumor: A rare case report

Phyllodes tumors (PTs) with extensive squamous metaplasia is an uncommon biphasic fibroepithelial neoplasms of breast, comprising of <1% of all breast neoplasm's. In this article, we report a case of a 55-year-old female patient admitted to the General Surgery Department with a rapidly enlarging, palpable mass in right breast. After histopathological examination, it was diagnosed to be as benign PT with extensive squamous metaplasia. Metaplastic changes are known, but infrequent in these tumors. Extensive squamous metaplasia within PT is rare and may occur in benign, borderline and malignant subtypes. There are only a few cases reported in the literature. We therefore, aimed to present this case in view of its extremely rare nature.

Synchronus Bilateral Breast Carcinoma (SBBC): A cytological diagnosis with review of literature

Introduction : A second primary breast cancer in the opposite breast can be either synchronous or metachronous. Bilateral synchronous breast cancer is defined as both cancers diagnosed within 3 months and neither can originate with metastasis from another tumour. Case Report : 40 year old female visited with complaint of mass in right breast and ulcer in left breast since 20 days with enlarged right axillary and left supraclavicular lymph nodes since last 2 months. Patient was referred for cytology of both lumps and lymphnodes. Cytological study of both lumps shown features of invasive duct carcinoma and lymph nodes shown metastatic deposits of carcinoma with similar morphological features as of breast lumps. Based on clinical presentation and cytological study case was diagnosed as synchronous invasive duct carcinoma. Conclusion : Synchronous breast cancer has poor prognosis hence early cytological and mammography detection helps in prompt management and thus decreasing morbidity as well as mortality.

Bilateral synchronous breast cancer in an elderly man: A case report

Bilateral synchronous breast cancers are seen extremely uncommonly in men. In this report, we describe a case of synchronous bilateral breast cancer in an elderly male without any significant risk factor. A 75-year-old male was presented with mass in right breast. After thorough clinical evaluation he underwent modified radical mastectomy for excision of tumor. Histopathologically, it was invasive duct carcinoma of grade II, stage II and positive for estrogen and progesterone receptors. Patient was managed with radiotherapy, adjuvant chemotherapy and oral tamoxifen 20 mg daily. After three months new lump in contra lateral breast was noticed. Again patient underwent modified radical mastectomy with diagnosis of invasive duct carcinoma of grade II and stage II. He received radiotherapy and hormone therapy. We managed the case of synchronous bilateral breast cancer successfully at our center. After bilateral modified radical mastectomy patient received radiotherapy, adjuvant chemotherapy and hormonal therapy with tamoxifen. Proper clinical evaluation, mammography and fine-needle aspiration cytology play important role in diagnosis of male breast cancer. In depth studies focusing on etiopathology of the disease are necessary to optimize the management of male breast cancer patients.

Incidentally discovered extensive squamous metaplasia within borderline phyllodes tumor: presentation of a rare tumor

Phyllodes tumors are uncommon biphasic fibroepithelial neoplasms of breast, comprising less than 1% of all breast neoplasms. We therefore aimed to present the case with its microscopic findings. In this article, we report a 59-year-old female admitted to the general surgery department with a rapidly, enlarging, palpable mass in right breast. After histopathological examination, it was diagnosed as borderline phyllodes tumor with extensive squamous metaplasia. Metaplastic changes are infrequent in the stromal and epithelial component of these tumors. Extensive squamous metaplasia within phyllodes tumor is rare and may occur in benign, borderline and malign subtypes.

Breast Sarcoma in Male: Case Report

INTRODUCTION: The primary sarcoma of chest wall is uncommon. Therefore there are a few series in the literature. Only 10% of all sarcomas are located in thorax and 1% of breast cancer is sarcoma. A small number of articles define prognostic factors of sarcomas from the trunk and less from the breast. In general, the highest incidence of sarcomas originating from thorax is in 47 years-old men and with fast growing. Tumoral size less than 5 cm and low histological grade are good prognostic factors. The adequate surgical approach is most important tool to treatment. We relate a case of breast sarcoma in 61 years-old man. CASE REPORT: A 61 years-old man has appeared with fast growing mass in thorax (right breast). No comorbities or previous thoracic irradiation. He had an exofitic mass in right breast measuring 13 cm in diameter and normal axillas. Core biopsy has showed fusiform cell neoplasia, moderate nuclear pleomorfism and histological grade 1. In March 2012, the surgical resection has done and the immunohistochemical and histopatological examination have concluded low grade sarcoma with negative margins, expressing vimentin and smooth muscle actin and his stage was T2BN0M0, IB. DISCUSSION: We related a sarcoma case in older man. This disease is more common between 45 and 50 years. In older man, this kind of cancer is associated to previous thoracical irradiation. Instead of that, our patient has never received any type of irradiation. He possesses only one bad prognostic criterion: tumoral size bigger than 5 cm. In general, the 10 years disease-free survival is about 63%, even though after surgical therapy. The surgical treatment maintains the most relevant therapy and the positive surgical margin can affect the prognosis.

乳腺原発顆粒細胞腫の１例

We report a case of primary granular cell tumor of the breast. A 40s female seen for an upper inner-quadrant right-breast mass was found in preoperative fine-needle aspiration cytology (FNAC) to have clustered or disassociated tumor cells with abundant granular cytoplasm and small oval nuclei. Cell boundaries were ill-defined. Extracellular granular materials were seen in the background. Histologically, we diagnosed granular cell tumor of the breast. Clinically, granular cell tumors mimic breast carcinoma, and pathologists should bear this in mind in FNAC to avoid a misdiagnosis of breast carcinoma.

Mammary Hibernoma

We report the case of a 39-year-old asymptomatic woman who presented for screening mammography. Mammography revealed a round, partially circumscribed, partially indistinct, noncalcified 4.5 cm mass in upper outer right breast. This vaguely palpable mass appeared as a well-circumscribed, oval, hyperechoic, parallel, septated mass on sonography. Ultrasound-guided core biopsy led to the diagnosis of hibernoma. Few cases of hibernomas have been reported in the English literature, and their occurrence in the breast is particularly rare [Eur J Surg Oncol 26 (2000) 430; Am J Surg Pathol 25 (2001) 809]. To our knowledge, this is the first case of mammary hibernoma in which the ultrasonographic and mammographic features of this unusual entity are demonstrated.

Radiologic-Pathologic Conference of The University of Ankara Medical School

5Department of Surgery, Ankara University Medical School, Ankara, Turkey. 75-year-old woman presented with a 6-month history of painless palpable mass in her right breast. Mammography revealed a 4-cm oval calcified mass in the upper outer right breast (Figs. 1A and 1B). A second 1cm lobulated mass was detected in the 12o’clock region. The patient underwent incisional biopsy of the palpable mass, which revealed invasive ductal cancer with osteochondrosarcomatous differentiation (Fig. 1C). Chest radiography and a bone scan were negative for distant metastasis. The patient underwent a right mastectomy. Histopathologic evaluation revealed a second 1.5cm focus of osteochondrosarcomatous metaplastic cancer in the 12-o’clock position in addition to residual metaplastic cancer at the A

Alveolar rhabdomyosarcoma metastatic to the breast

A 12-year-old girl was initially seen with a soft tissue mass in the upper outer quadrant of the right breast and a soft tissue mass within the right soleus muscle. Mammography showed a 5-cm round mass in the upper outer right breast (Fig 1, A). On sonography, the mass was hypoechoic and solid with lobulated margins. Color Doppler sonography showed the lesion to be highly vascular (Fig 1, B). Magnetic resonance imaging showed a well-demarcated mass that was hypointense on T1-weighted images (Fig 1, C) and

A case report of pancreas head cancer metastasizing to breast and pericardium

A 27 year old female patient, married, presented with a mass in left breast and two masses in right breast, was abdominal delivered of a female infant at full term halfa year ago.