Solid-tubular Type Research Articles

Radiation-induced low-grade fibromyxoid sarcoma of the chest wall nine years subsequent to radiotherapy for breast carcinoma: A case report.

The present study reports a case of low-grade fibromyxoid sarcoma that occurred in a 62-year-old woman 9 years subsequent to whole breast irradiation for a carcinoma of the left breast, and 18 years following chemotherapy and radiotherapy (RT) for non-Hodgkin's lymphoma (NHL; diagnosed at the age of 43). The patient was 53 years of age when a cT2N0M0 stage IIA breast tumor was identified and excised. A 2.5 cm diameter nodule with dimpling in the upper-outer region of the left breast was detected. Pathological examination revealed that the tumor was an invasive ductal carcinoma, of a solid tubular type. The patient was treated with post-surgical whole breast RT. The left breast received 46 Gy in 23 fractions (2 Gy per fraction) for 4 weeks and 3 days, followed by a cone down boost of 14 Gy in 7 fractions (2 Gy per fraction); therefore a total dose of 60 Gy in 30 fractions was administered. In total, 9 years subsequent to RT, the patient observed a small lump in the left chest wall. The patient underwent excision of the tumor and pectoralis major fascia. Microscopically, the tumor consisted of atypical spindle cells with myxoid stroma. Pathologists concluded that the tumor was a low-grade fibromyxoid sarcoma. Since the tumor developed from tissue in a previously irradiated region, it was considered to be RT-induced, and was classified using the radiation-induced sarcoma (RIS) criteria as dictated by Cahan. Although the majority of RIS cases are angiosarcomas, a rare, low-grade fibromyxoid sarcoma was observed in the present study. The present study hypothesizes that there may have been an overlap region between the RT for supraclavicular nodes of NHL and the whole breast RT for primary breast cancer, due to the results of a retrospective dose reconstruction undertaken by the present study. The patient remained clinically stable for 4 years thereafter, until 2008 when the patient experienced a local relapse and underwent surgery. On 19 October 2011, the patient succumbed to RIS. The current study suggests that the RT history of a patient requires consideration due to the possible development of RIS, including the development of a low-grade fibromyxoid sarcoma, which may lead to a poor prognosis.

Metastatic gastric carcinoma from breast cancer mimicking primary linitis plastica: A case report.

Metastases to the gastrointestinal tract rarely occur in breast cancer except in invasive lobular carcinoma. The present study reports a rare case of metastatic gastric cancer from invasive ductal carcinoma (IDC) of the breast mimicking primary gastric linitis plastica. A 51-year-old premenopausal female, who had a history of partial mastectomy for right breast cancer at the age of 40, was referred to Toyama City Hospital (Toyoma, Japan) for an endoscopic diagnosis of gastric linitis plastica. Abdominal computed tomography (CT) revealed left hydronephrosis, while peritoneal metastasis and malignant ascites were not detected. Chest CT detected a left lung tumor, which had invaded the left upper bronchus. Biopsy specimens were obtained and the histopathological findings on both the gastric tumor and lung tumor demonstrated poorly differentiated adenocarcinoma, whereas the histology of the original breast cancer was IDC with a solid-tubular type. Immunohistochemistry revealed that the biopsied specimens of the gastric and lung tumors were positive for estrogen receptor (ER), progesterone receptor (PgR) and negative for human epithelial growth factor receptor-2 (HER2). These molecular characteristics indicated the case was metastatic gastric carcinoma from the breast cancer with lung metastasis, since the statuses of ER, PgR and HER2 were concordant with those of the original breast cancer. However, the possibility of primary gastric cancer could not be completely ruled out. Therefore, a total gastrectomy was performed for the purpose of both diagnosis and treatment. Pathological examination of the resected specimen provided a definite diagnosis of multiple metastatic gastric carcinomas from the breast. To the best of our knowledge, metastatic gastric cancer derived from the breast presenting as linitis plastica 11 years following the surgical removal of IDC has not been described previously.

Evaluation of clinicopathological features from core needle biopsy and CT imaging as predictors of response to primary systemic therapy for operable breast cancer

11086 Background: Primary systemic therapy (PST) is standard therapy for patients with locally advanced breast cancer and increasingly used for early-stage operable disease. Clinical and pathologic responses are important prognostic parameters and clinicopathological markers to predict response to PST are needed to individualize treatment. Methods: From 1998 to 2005, 403 primary breast cancer patients were underwent curative surgical treatment after PST (Anthlacycline and/or Taxane) at NCCH. We retrospectively evaluated the clinicopathological features (age, histological type, histological grade, ER, PgR and HER-2) and classification of tumors using CT (localized tumor type and diffused tumor type) at before PST and analyzed the correlation with clinical response and pathological complete response (pCR). The log-rank statistic was used for univariate comparisons and multivariate analysis performed using Cox hazard model. Results: Overall response and pCR rate were 87% and 18%. Breast conserving surgery was performed 37% patients. Histological grade 3 (p<0.0001), ER negative (p<0.0001), PgR negative (p<0.0001), solid-tubular type (p=0.0006), age (>50) (p=0.008) and localized tumor type (p=0.02) correlated with pCR. In multivariate analysis, Histological grade 3 (p=0.01) and localized tumor type (p=0.036) were independent predictors for pCR. ER positive, histological grade 2 or 1, invasive lobular carcinoma and diffuse tumor type associated with low chemosensitivity and low breast conserving surgery rate. Conclusions: Clinical and pathological response significantly associated with ER status and histological grade. Furthermore the classification of tumor type using CT was effective to predict of response to PST. No significant financial relationships to disclose.

Correlation of KIT and EGFR overexpression with invasive ductal breast carcinoma of the solid‐tubular subtype, nuclear grade 3, and mesenchymal or myoepithelial differentiation

Although KIT and EGFR overexpressions are reported to occur in breast cancer, their pathological significance is still unclear. We examined KIT, EGFR, and c-erbB-2 overexpressions immunohistochemically in 150 cases of surgically resected breast cancer and their correlation with the histological type and grade and mesenchymal and/or myoepithelial immunophenotype of primary tumors. To facilitate the analysis, we constructed a tissue microarray comprising 2-mm diameter tissues cored from the representative tissue block of each tumor. KIT, EGFR, and c-erbB-2 overexpressions were detected in 15 (10%), 12 (8%), and 23 (15%), respectively. The KIT was more frequent in the group comprising comedo-type ductal carcinoma in situ and invasive ductal carcinomas (IDCs) of the solid-tubular subtype than in the group of other histological types (P=0.027), and the EGFR was more frequent in IDCs of solid-tubular type than in other histological types (P <0.05). KIT and EGFR overexpressions were correlated with nuclear grade 3 (P=0.0095 and 0.0005) and tended to be concurrent (P=0.005). KIT overexpression was correlated with vimentin and S-100 expression (P=0.003 and P=0.005), and EGFR overexpression was correlated with S100 expression (P=0.0001). These correlations with grade and mesenchymal/myoepithelial markers were not observed for c-erbB-2 overexpression. KIT and EGFR appeared to be indicators of high-grade breast carcinoma groups that often contain the carcinomas with mesenchymal and/or myoepithelial differentiation, which are distinct from the group with c-erbB-2 overexpression.

Histological classification of invasive ductal carcinoma and the biological parameters in breast cancer.

The histological classification of invasive ductal carcinoma proposed by the Japanese Breast Cancer Society is based on the appearance of breast cancer invasion. However, few studies have been done to clarify the relationship between the histological classification and other parameters that represent the biological characteristics of individual breast cancer cells. We analyzed 1,025 invasive ductal carcinomas, consisting of 424 papillotubular, 330 solid-tubular and 271 scirrhous cases, with regard to the status of estrogen receptor (ER), progesterone receptor (PgR), DNA ploidy, epidermal growth factor receptor (EGFR) and p53 protein. Absence of ER and PgR, aneuploidy, EGFR positivity and p53 protein positivity were all observed significantly more frequently in solid-tubular tumors than in the other two types. In addition, the number of abnormal features with regard to these 5 biological parameters was also significantly higher in solid-tubular tumors than in the other two types. Abnormalities in the biological parameters listed above were frequently found in the solid-tubular type of invasive ductal carcinoma.

Clinicopathologic analysis of BRCA1- or BRCA2-associated hereditary breast carcinoma in Japanese women

The purpose of this investigation was to elucidate the clinicopathologic characteristics of BRCA1- and BRCA2-associated hereditary breast carcinomas (HBCs) in Japanese women. Various clinicopathologic characteristics of HBCs arising in patients with BRCA1 or BRCA2 germline mutations were compared with those of the control group (sporadic breast carcinomas). The mean age at the time of diagnosis of BRCA1-associated HBCs and that of BRCA2-associated HBCs (44 years for both) were significantly younger than that of the control group (54 years) and the incidence of bilateral tumors was significantly higher in the BRCA1-associated HBCs (32%) and BRCA2-associated HBCs (29%) than in the control group (6%). BRCA1-associated HBCs showed a tendency (P = 0.06) toward an increase in solid-tubular type tumors and a significant increase in histologic grade 3 tumors (P < 0.01) and lymphatic invasion positive tumors (P < 0.05) compared with the control group. BRCA1-associated HBCs were significantly more estrogen receptor negative (P < 0.01), c-erb B-2 negative (P < 0.05), and p53 positive (P < 0.01), and they also showed a significant increase in MIB-1 staining grades (P < 0.01) as well as microvessel counts (P < 0.05) compared with the control group. However, there was no significant difference in these parameters between the BRCA2-associated HBCs and the control group. BRCA1-associated HBCs in Japanese women have biologically aggressive phenotypes. However, BRCA2-associated HBCs are without distinctive clinicopathologic features compared with sporadic breast carcinomas.

Histopathological aspects of breast cancer in relation to some epidemiological risk factors

Penelitian epidemiologik dengan cara kasus kontrol pada 300 kasus kanker payudara di Rumah Sakit Dr. Cipto Mangunkusumo, telah dilakukan pada tahun 1989-1991. Dengan menggunakan klasifikasi yang dianjurkan oleh Japanese Breast Cancer Society, gam­ baran histopatologik kanker payudara menunjukkan bahwa dari tipe karsinoma duktus invasif, jenis skirus ditemukan pada 147 kasus ( 49%), jenis padat tubuler pada 79 kasus ( 26.33%) dan jenis pa pilotubuler pada 39 kasus ( 13%). Sedang dengan menggunakan klasi­ fikasi WHO ( 1981), ditemukan 265 kasus ( 88.33%) invasif duktus karsinoma, karsinoma invasif lobuler pada 7 kasus ( 2.33%), karsinoma moduler pada 17 kasus ( 5.68%), karsinoma adenoid kistik pada 1 kasus (0.33%), penyakit Paget pada puting 2 kasus (0.67%) dan 4 kasus pada karsinoma noninvasif adalah karsinoma duktal insitu. Analisa terhadap faktor-faktor risiko yang bermakna pada kanker payudara wanita Indonesia menunjukkan bahwa faktor-faktor: aktivitas seksual dini, tinggal di daerah perkotaan, trauma payudara, obesitas ( kegemukan), haid pertama/menarche yang terlambat, siklus haid yang tidak teratur, menopause, konsumsi makanan berlemak dan yang mengandung santan dapat meningkatkan risiko. Juga telah dianalisa hubungan antara faktor-faktor risiko yang bermakna tersebut dengan jenis histopatologik. Hasilnya menunjukkan bahwa Konsumsi makanan bersantan meningkatkan kemungkinan jenis karsinoma duktus invasif. Pengaruh tersebut berhubungan dengan ketiga subtipe histologik, yaitu papiler tubuler; solid tubuler dan skirus. Konsumsi minuman dengan santan/air kelapa dan sayuran segar menurunkan kemungkinan jenis tersebut, dengan sifat tidak bergantung kepada subtipe histologik. Abstract Case control epidemiological study of 300 breast cancer cases from Dr. Cipro Mangunkusumo Hospital has been performed in 1989-1991. By applying the Japanese Breast Cancer Society classification, the histopathological pattern of breast cancer showed that from the invasive ductal carcinoma type, scirrhous type was found in 147 cases (49%), solid-tubular type in 79 cases ( 26.33%) and papilotubular type in 39 cases ( 13%). According to WHO classification ( 1981); they were diagnosed as: invasive ductal carcinoma in 265 cases ( 88.33%), invasive lobular carcinoma in 7 cases ( 2.33%), medullary carcinoma in 17 cases ( 5.68%), adenoid cystic carcinoma in 1 case (0.33%), pure Paget's disease of the nipple in 2 cases (0.67%) and 4 cases ( 1.33%) of the noninvasive carcinoma were ductal carcinoma in situ. Analysis of the significant risk factors among the Indonesian female breast cancer revealed that thefollowing factors: living at urban area, young sexual activity, trauma, obesity, late menarche, irregular cycle, menopause, fatty diet and coconut milk con­ taining food consumption increased the risk. Relationship of the risk factors to histopathological types has been stastistically analyzed. The results showed that increased possibility to have the invasive ductal carcinoma was related to consumption of coconut milk containing food. The effect was related to the three histological subtypes, namely: papillary tubular, solid tubular and scirrhous types. Coconut milk drinks and fresh vegetables showed decreasing effect, which was irrespective to subtypes. Keywords: Breast cancer, histopathological, epidemiological, risk factors .

Frequent Allelic Loss at 6q26-27 in Breast Carcinomas of the Solid-tubular Histologic Type.

To characterize the effect that inactivation of a putative tumor suppressor gene on 6q appears to have on breast carcinogenesis, we examined loss of heterozygosity in 528 primary breast carcinomas with a polymorphic marker located at 6q26-27, a frequent target region of allelic loss in ovarian and breast cancers. Ofthe 56 informative tumors of the solid-tubular type, 29(52&precnt;)showed allelic lossat 6q26-27;however, only 10 of 42 papillotubular carcinomas(23%)and 34 of 86 scirrhous carcinomas(39%)showed allelic loss(p = 0.0215). These results are consistent with reported alterations at 6q26-27 in serous and mucinous types of ovariancancers, in that they suggest that inactivation of one or more genes in that region may affect carcinogenic mechanisms in a histologic type-specific manner in neoplasms of the female reproductive organs.

Correlation of Allelic Losses and Clinicopathological Factors in Primary Breast Cancers.

Human breast cancers frequently show allelic loss or loss of heterozygosity (LOH) at apecific chromosomal regions. To understand the possible role of these genetic alterations in tumor development and progression, we examined LOH at loci on chromosomal arms 1p, 3p. 11p, 13q, 16q, 18q, and 22q in 140 to 246 cases of primary breast cancers and compared it with lymph node metastasis, histological type, tumor stage, estrogen receptor (ER) and progesterone receptor (PgR) status. LOH at 1p22-31 correlated with lymph node metastasis and a tumor size of greater than 2 cm. LOH at 13q12-14 and 18q21 were most frequently observed in tumors of the solid-tubular type. LOH at 1p34-36 was more frequent in tumors of the scirrhous and solid-tubular types than in other less aggressive histological types. Furthermore, a significant association was observed between LOH at 3p14-21, 11p11-15 and 13q12-14 and the absence of progesterone receptors. These results suggest that some clinical characteristics of breast cancers are determined by loss of tumor supperssor genes present at specific chromosomal regions.

Mapping of a breast cancer tumor suppressor gene locus to a 4-cM interval on chromosome 18q21.

DPC4 and DCC, putative tumor suppressor genes implicated in the genesis of several types of human cancer, lie on the long arm of human chromosome IS. We examined 200 primary breast cancers for allelic losses on chromosome IS, using 15 microsatellite markers distributed along the long arm. Allelic loss was detected most frequently (29–30%) at loci mapped to 18q21. Deletion mapping of the 34 tumors showing partial or interstitial deletions identified a commonly deleted region within the 4‐cM interval flanked by D18S474 and D18S487 at 18q21.1‐q21.3. Although this interval included the DPC4 and DCC genes, we excluded DPC4 from candidacy when polymerase chain reaction‐single‐strand conformation polymorphism analysis of each exon failed to detect abnormalities in any of the 54 breast cancers that exhibited loss of heterozygosity involving 18q. Allelic loss on 18q was found more frequently in tumors of the solid tubular histological type (24 of 55, 44%) than in other types (24 of 113, 21%) (P=0.0049). The results suggest that a tumor suppressor gene located within the 4‐cM region at 18q21, either DCC or another gene not yet identified, may play a role in the development of some sporadic breast cancers, particularly those of the solid tubular type.

Fine needle aspiration cytology of palpable breast lesions. Histologic subtype in false negative cases.

To evaluate the use of fine needle aspiration cytology (FNAC) in the management of benign and malignant breast disease in an outpatient breast clinic and to determine the guidelines for reporting on FNAC of breast lesions, we evaluated the test results in correlation with the histologic diagnosis. We evaluate the test results of 669 cases of FNAC of the breast in 17 months in our outpatient breast clinic in correlation with the histologic diagnosis, histologic subtype according to the Japan Mammary Cancer Society classification and mammography results in false negative cases. Among 669 cases, 25.3% were inadequate for cytologic diagnosis. An analysis of the results using the two-by-four contingency table, including cases with inadequate cytologic diagnosis, showed that 10.6% and 1.0% had false negative and false positive cytologic diagnoses, respectively; sensitivity and specificity were 76.9% and 91.6%, respectively. The false negative rate of 10.6% was higher than expected, and those belonged mostly to the "inadequate" cytologic diagnosis category even though they were discrete, obviously malignant masses clinically. To try to explain this, we compared the cytologic results and histologic subtype according to the Japan Mammary Cancer Society classification and the mammography results. Of 73 cases of infiltrating ductal carcinoma in which retrospective reexamination of the histology slide was possible, 27 (37.0%) were papillo-tubular type, 11 (15.1%) were solid-tubular type and 35 cases (47.9%) were scirrhous type. Although the scirrhous subtype was only 37.0% in the group in which a cytologic diagnosis of carcinoma was possible, more than two-thirds of the cases of false negative cytology were scirrhous type and had malignant mammographic findings. This finding was statistically significant. In cases of ductal carcinoma of scirrhous subtype, the FNAC tended to be inadequate and false negative, but mammography showed better discrimination in such cases.

Two distinct commonly deleted regions on chromosome 13q suggest involvement of BRCA2 and retinoblastoma genes in sporadic breast carcinomas

Frequent allelic losses on the long arm of chromosome 13 in sporadic breast carcinomas suggest that a tumor suppressor gene(s) on 13q is involved in this type of carcinoma. The presence of a familial breast carcinoma susceptibility gene, BRCA2, and the retinoblastoma susceptibility gene (RB) on the same chromosomal arm implies that one or the other, or both, of these genes may be critically affected by those allelic losses.To investigate the possible involvement of BRCA2 and RB in sporadic breast carcinomas, the authors examined allelic losses in 246 breast carcinomas with 14 polymorphic microsatellite markers on 13q12.q14.Allelic loss was observed in 95 of the 246 sporadic breast carcinomas (39%). Detailed deletion mapping identified two commonly deleted regions. The more proximal of these two segments was located in a 6-cM interval flanked by marker loci D13S289 and D13S267 and containing the BRCA2 gene; the more distal region was located in a 9-cM interval flanked by marker loci D13S328 and D13S172 and containing the RB gene. Allelic loss on 13q was found more frequently in tumors of the solid tubular histologic type (36 of 66; 55%) than in other types (52 of 146; 36%) (P = 0.0096). Furthermore, a significant association was observed between allelic loss on 13q and the absence of progesterone receptor (P = 0.0001).The results indicate that BRCA2 and RB are independent targets of allelic loss and that inactivation of either of these genes may play a role in the development of some sporadic breast carcinomas, particularly those of the solid tubular type.

Two distinct commonly deleted regions on chromosome 13q suggest involvement of BRCA2 and retinoblastoma genes in sporadic breast carcinomas.

Frequent allelic losses on the long arm of chromosome 13 in sporadic breast carcinomas suggest that a tumor suppressor gene(s) on 13q is involved in this type of carcinoma. The presence of a familial breast carcinoma susceptibility gene, BRCA2, and the retinoblastoma susceptibility gene (RB) on the same chromosomal arm implies that one or the other, or both, of these genes may be critically affected by those allelic losses. To investigate the possible involvement of BRCA2 and RB in sporadic breast carcinomas, the authors examined allelic losses in 246 breast carcinomas with 14 polymorphic microsatellite markers on 13q12.q14. Allelic loss was observed in 95 of the 246 sporadic breast carcinomas (39%). Detailed deletion mapping identified two commonly deleted regions. The more proximal of these two segments was located in a 6-cM interval flanked by marker loci D13S289 and D13S267 and containing the BRCA2 gene; the more distal region was located in a 9-cM interval flanked by marker loci D13S328 and D13S172 and containing the RB gene. Allelic loss on 13q was found more frequently in tumors of the solid tubular histologic type (36 of 66; 55%) than in other types (52 of 146; 36%) (P = 0.0096). Furthermore, a significant association was observed between allelic loss on 13q and the absence of progesterone receptor (P = 0.0001). The results indicate that BRCA2 and RB are independent targets of allelic loss and that inactivation of either of these genes may play a role in the development of some sporadic breast carcinomas, particularly those of the solid tubular type.

A CASE OF DOUBLE CANCER IN THE MALE BREAST AND STOMACH

A 64-year-old male, who had been operated on for cholelithiasis 20 years earlier was pointed out liver cirrhosis since 4 years before. Recently, he noticed a hard tumor with tenderness in his right breast, growing gradually in size. Maligant cells were detected by aspiration cytology, and modified radical mastectomy was performed. High levels of both estrogen and progesteron receptors were recongnized in the breast cancer tissues postoperatively. Histologically the breast cancer was invasive ductal carcinoma, solid tubular type. Postoperative course was uneventful and the patient was discharged. Then, 10 months later, he complained of epigastric pain. Subtotal gastrectomy was performed because of the presence of gastric cancer by gastric mucosal biopsy. Histopathological examination revealed two foci of mucosal gastric cancer, each consisting of well-differentiated tubular adenocarcinoma and signet ring cell carcinoma, in stage Ia. There has been no recurrence or metastasis after the operation. This very rare case is the 11th case of double cancer in the male breast and stomach in the Japanese literature.

A CASE REPORT OF ADVANCED BREAST CANCER TREATED WITH WIDE LOCAL RESECTION AND OMENTAL FLAP

We report an advanced breast cancer infiltrating into the axillar area in a 38-year-old woman. The patient who had noticed a right breast tumor 5 years ago visited our hospital complaining of enlargement of the mass at the right breast with the right arm swollen and hardened severely. Venography showed that this tumor infiltrated into the axillar vessels, and bone scincigram revealed metastasis to the right 3rd, 4th and 5th ribs. By CAF treatments for 7 courses associated with hormone and immunotherapy, this tumor was reduced remarkably, and then operation was performed. Excision of wide locality and chest wall, and reconstruction using Lesin covered with dermal flap, omental flap and mesh skin graft were carried out. Histological examination showed invasive ductal adenocarcinoma, solid tubular type. This patient is doing well 9 months after surgery.