Left Breast Tumor Research Articles

073. Tamoxifen - Associated Hirsutism: An Usual Side Effect in A 52-Year-Old Women with Malignant Neoplasm of Left Breast

Background: Hirsutism is a condition characterized by growth of excessive male-pattern (i.e., face, chest, abdomen, lower back, upper arms, and thighs) hair in women. The prevalence of hirsutism has been reported to be between 5% and 15% in women and can be caused by various factors, including the use of medications such as Tamoxifen. The modified Ferriman-Gallwey (mFG) score is the preferred and most widely used method for scoring excess terminal hair in the assessment of hirsutism. This case report aims to explore the relationship between Tamoxifen use and the development of hirsutism, as well as to discuss the potential mechanisms involved. Case: A 52-year-old female patient was diagnosed with a left breast tumor and underwent neoadjuvant chemotherapy followed by treatment with Tamoxifen 10 mg daily for six months. After treatment, the patient reported abnormal hair growth on her face, chest, arms, and legs. Conclusion: The use of Tamoxifen may contribute to the development of hirsutism in some patients. It is important to monitor these side effects and consider appropriate management strategies for patients experiencing hirsutism related to treatment.

Distributions of Breast Cancer Primary Tumor Locations in Indonesian Patients

<p><strong>Introduction:</strong> Overseas studies have shown various distributions of breast cancer primary tumor locations based on stages and histopathologic types. Based on them, breast cancer was consistently reported to be found on theleft breast more than the right. Breast cancer laterality was estimated to be one of the determinant factors in prognosis. In Indonesia, there are only a few studies on the laterality of breast cancer, as well as the characteristics that accompany it. The aim of this study is to know the distributions of primary breast cancer tumor locations in Indonesian patients.</p><p><strong>Material and Methods:</strong> A cross-sectional design study was done and the data was collected from Siloam Hospital Lippo Village radiology and pathology anatomy department within the 2014-2018 period. The results were presented using descriptive statistics.</p><p><strong>Results:</strong> A total of 74 breast cancer patients from various ages and stages were enrolled in this study. Based on the histopathological types, 84.2% patients left breast tumors and 72.2% patients with right breast tumors had invasive ductal carcinoma of no special type. Based on quadrants, 50% tumors on the left breast are in the superolateral quadrant, followed by 31.6% in superomedial, 13.2% in inferomedial, and the rest in inferolateral. Conclusion: Most tumors are located in the superolateral quadrant and the most histopathological types are non-specific invasive carcinomas.</p>

TUMOR FILÓIDE MALIGNO: UMA NEOPLASIA MAMÁRIA RARA E AGRESSIVA

Phyllodes tumor (PF) of the breast is uncommon neoplasms which consisting in a fibroepithelial, circumscribed, with foliaceous structure, composed of epithelial and connective tissue. Often, affects woman aged between 40 and 50 years. According to the World Health Organization (WHO), the PF has three forms – benign, borderline and malignant. The treatment is surgical. The effects of radiotherapy and adjuvant chemotherapy are still uncertain. This study reports the case of a 54-years-old patient, feminine, admitted to a specialty clinic with presence of left breast tumor for six years, without seeking any assistance previously. Was submitted to be left mastectomy in a tertiary hospital. After the procedure, the anatomopathological analysis revealed a phyllodes tumor. At the time reassessment, apresent good looking surgical scar and is being followed-up with clinical oncology and motor physiotherapy. The patient remains to this day with a good quality of life and no signs of recurrence.

A Rare Case of Multiple Bilateral Fibroadenoma in a Young Woman: A Case Report and Literature Review

Background: Fibroadenoma is the most common type of breast tumor diagnosed in young women, in children and adolescents it is called juvenile fibroadenoma. These tumors often result in emergence, self-confidence, and anxiety in adolescents. Case Report: A 21-year-old female patient came to the surgical clinic with lumps in the right and left breasts since about 4 years ago. History and physical examination showed the right and left breast tumors were suspiciously benign. Ultrasound results showed multiple hypoechoic (solid) lesions, on the right breast the largest size was 4 cm, with BIRADS 2, the left breast the largest size was 3.5 cm, with BIRADS 2. The patient then underwent surgical excision of the tumor and performed histopathological examination. The results of histopathological examination provide an overview of fibroadenoma. Conclusion: The presentation of the case report from the authors hopes to expand the literature and provide insight into multiple fibroadenoma and the need for anamnesis, comprehensive physical examination, accompanied by ultrasonography to FNA in a young female patient who has a lump in the breast.

GIANT FIBROADENOMA OF BREAST IN A MATURE WOMEN -A CASE REPORT

Introduction: Fibroadenomas are common benign lesions of the breast that are usually found young patients. Giant broadenomas are uncommon benign lesions, dened as broadenomas of >5 cm in size, which are usually found in patients of less than 20 years of age. A Presentation Of Case: 39-year-old premenopausal woman presented with a left breast tumor that had rapidly increased in size and which showed ulceration and bleeding. Needle biopsy showed cohesive clusters of benign ductal epithelial cells against bare nuclei in background. Lumpectomy was perfomed. Histopathology conrmed the diagnosis of giant broadenoma. In comparison to all previous Discussion: reports on patients with giant broadenoma, this patient was relatively old and the etiology was unknown. Although rare, an appropriate therapeutic strategy should be decided according to the results of a histopathological examination. Early treatment Conclusion: could allow breast preserving surgery and patients should be recommended to undergo reexamination with awareness of progression

Epidemiological Study of CA Breast in Diyala

Background: Breast cancer is becoming the most common cancer among women in both developed and developing countries . Breast cancer has been the leading cause of death among Iraqi women for three decades, and it is the second leading cause of death after cerebrovascular illnesses.Objective: To investigate the epidemiological and clinic pathological behavior of breast cancer in Diyala province.Patients and Methods: A retrospective cross-sectional study conducted at the Oncology Clinic of Baquba Teaching Hospital for 24 months between April 1st and March 31st, 2021. A sample of (257) patients was selected to collect socio-demographic information (age, gender, marital status, history of breast lactation ,history of contraceptive pills, history of breast cancer in family, parity status). Results: The current study shows that more than 55% of the patients were under the age of (50) years. Two hundred fifty one patients (97.6%) were female and( 6) patients (2.4%)were male. from the 251 female patient . Right breast tumor was found in 120 patients (48%) and left breast tumor was found in (127) patients (50.4%) and bilateral breast tumor in (4) patients(1.6%). In terms of breast cancer family history, 28 patients(11%) had a positive family history, while 223 patients (89%) had a negative family history. One hundred fifty seven of patients(63%) had history of breastfeeding and( 94) of patients(37%) had no history of breastfeeding . One hundred forty six patients (58%) had positive history of oral contraceptive pill while 105 patients (42%) had negative history of oral contraceptive pill. twenty two patients (9%) had positive history of smoking while (229) patients (91%) had negative history of smoking . The histopathological result were Invasive ductal carcinoma (I.D.C) in (233) patients (93%) and Invasive lobular carcinoma (I.L.C) in (18) patients. Breast cancer patients were married in 73% of cases, widowed in 13.5 percent of cases, divorced in 2.5 percent of cases, and single in 11% of cases. Most cases belonged to differentiation stage II ( 159) patients (63%), followed by stage III ( 57) patients (23%) , stage I ( 13) patients (5%) and stage IV (22) patients(9%) . Conclusion: The current study concludes that In Iraq, the majority of breast cancer patients were in the second stage, and patients' ages at diagnosis were younger than in other communities. The development and execution of screening programs, as well as the management of risk factors, appear to be critical. Keywords: Breast, Cancer, Patients

Dermatitis neglecta in a patient with breast fibroadenoma: case report

Dermatitis neglecta, a condition that results from inadequate skin cleansing, is still little reported in the literature and underreported. Although benign, it is aesthetically uncomfortable. It is associated with conditions that lead to fear of sanitizing a given region and may be related to psychiatric and neurological disorders. This observational study consisted of the case report of a patient followed up in a University Hospital in northeastern Brazil, with the objective of demonstrating the rare association between dermatitis neglecta and breast fibroadenoma. A young patient with a history of depressive disorder had crusted and hyperpigmented skin lesions covering the left breast and massive tumor in the same breast. The patient was oriented regarding the cleaning and removal of crusts, resulting in good clinical response. She underwent excision of the tumor, and the anatomopathological study was compatible with fibroadenoma. Interdisciplinary follow-up, including treatment for psychiatric disorder, was fundamental for the patient’s recovery, considering the improvement of her mood after establishing the therapy and successful final breast reconstruction. Dermatitis neglecta can resemble other types of dermatitis, in such a way that it is essential to establish a differential diagnosis to avoid unnecessary evaluation procedures, interventions, and therapies. In this exuberant case of dermatitis neglecta, the importance of comprehensive health care is emphasized.

A Dosimetric Analysis of Reduction Cardiac Dose with Lead Shielding in Breast Cancer Radiotherapy

Adjuvant radiotherapy is an important treatment modality after breast-conserving surgery. Due to its proximity, radiation therapy for the left breast can often lead to an escalated heart dose that can result in heart diseases. The purpose of this study was to evaluate the heart dose reduction by using lead shields surrounding the left breast. The doses of a 3D conformal radiotherapy (3D-CRT) plan, an intensity-modulated radiotherapy (IMRT) plan, and volumetric-modulated arc therapy (VMAT) to the left breast tumor in a CIRS ATOM anthropomorphic female adult phantom were measured by optically stimulated luminescence dosimeters (OSLDs). To protect critical organs, the skin around the target area was covered by lead shields of two different thicknesses (0.125 mm and 0.25 mm). The results showed that compared to IMRT and 3D-CRT, VMAT provided better planning target volume (PTV) coverage, a better conformity index (CI), and homogeneity index (HI). With the use of lead shields, the thyroid dose was reduced by 5.12–27.5% and 20.51–30%, respectively; the heart dose was reduced by 49.41–50.12% and 56.38–57.42%, respectively; and the lung dose was reduced by 1.23–45.22% and 0.98–57.83%, respectively. Although the clinical application of lead shields was rare, this study verified that it could effectively decrease the heart dose from 4.31 ± 0.09 Gy to 1.88–2.18 Gy, thereby potentially reducing the risk of associated heart diseases by 14.8%. Further works to implement this method into clinical practice are needed.

Predominance of RAD21 and ERBB2 amplification and progesterone receptor positivity in tumors of the right breast support breast cancer lateralization.

e12557 Background: Biologic lateralization broadly impacts breast cancer. Malignancies originating in the left breast compared to the right breast tend to be more frequent, larger and of poorer prognosis. Left breast tumors respond differently to HER2-neu signaling and have lateralized Ki67 expression. In a prior study a right-left asymmetry in the neutrophil/lymphocyte ratio (NLR) of breast cancers was identified (ASCO 2018, e13094). As a follow-up, retrospective analysis of results from comprehensive genomic profiling (CGP) of right and left side breast cancer specimens was performed to determine a potential genomic etiology for the observed NLR lateralization. Methods: Tumors from 43 consecutive breast cancer patients underwent analysis for all classes of genomic alterations by hybrid capture-based CGP (Foundation Medicine). The CGP results from the 25 left- and 18 right-sided breast cancer samples were analyzed along with the histologic grade and status of estrogen receptor (ER), progesterone receptor (PR), and HER2 expression. Results: In this cohort of advanced breast cancer patients (stage 3-4), no statistically significant differences in lateralization were identified based on patient age, tumor stage, or frequency of ER or Her2 expression (Table). A predominance of PR positivity (p=0.14 chi square analysis) and amplifications in the ERBB2 (p=0.37) and RAD21 (p=0.08) genes were detected in right side tumors. Conclusions: Together with the prior study, trends in asymmetry based on genomic, pathologic, and immunohistologic differences have been detected in breast cancers, including an increased incidence of ERBB2 and RAD21 amplification in right-side breast tumors in this cohort. The predominance of lower PR positivity in the left breast tumors may be due to preferential hypermethylation, consistent with reports that it mediates biologic lateralization changes, downregulates PR expression, and alters amplification rates. Epigenetic methylation, may contribute to asymmetric breast cancer biology and have implications for therapeutic strategy. Further study is warranted.[Table: see text]

Primary Breast Diffuse Large B-Cell Lymphoma in a 42-Year-Old Female: A Case Report and Review of Literature

Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare localized extranodal lymphoma. It is mainly diagnosed by pathological examination due to the lack of specific clinical and imaging manifestations. Whole-body positron emission tomography-computed tomography (PET-CT) is widely used in determining clinical staging and guiding clinical treatment. As part of comprehensive treatment, targeted therapy with rituximab, intrathecal methotrexate injection and consolidation radiotherapy remain controversial in treating PB-DLBCL, but the comprehensive treatment based on full-course of chemotherapy is still widely used as the first-line treatment. Comprehensive treatment often leads to a sharp decline in the immunity of elderly patients with malignancy. In this situation, surgery may be a good chance to improve their life quality without serious complications. We present a rare case of PB-DLBCL during the coronavirus disease 2019 (COVID-19) pandemic. The patient underwent chest CT scan to screen COVID-19 and a mass of left breast was accidentally found. Because of the city lockdown policy in Wuhan, she did not seek medical help until noticing that the mass was gradually enlarged. Both ultrasonography and mammography indicated that the lesion was breast cancer. However, ultrasound-guided core needle biopsy revealed diffuse large B-cell lymphoma of breast and PET-CT scan showed that the lesion was a primary hypermetabolic tumor of left breast. The patient subsequently received comprehensive treatment based on six cycles of rituximab-cyclophosphamide, hydroxydaunomycin, oncovin, prednisone (R-CHOP) chemotherapy. J Med Cases. 2021;12(5):181-185 doi: https://doi.org/10.14740/jmc3660

Long-term survival after pancreatic metastasis resection from breast cancer: a systematic literature review

BackgroundPatients with advanced-stage breast cancer often demonstrate pancreatic metastases. However, pancreatic metastases resection from breast cancer has been rarely performed, with only 20 cases having been reported to date.Case presentationA 49-year-old woman presented to our hospital in September 2003 with complaints of uncontrollable oozing from her left breast tumor. Computed tomography revealed a left breast tumor approximately 9.3 cm in diameter as well as heterogeneously enhanced solid mass lesions with necrotic foci in the pancreatic tail and body, up to 6.2 cm, which were radiologically diagnosed as pancreatic metastases from breast cancer. An emergent left simple mastectomy was performed to control bleeding. After epirubicin and cyclophosphamide hydrate treatment failed to improve her condition, the pancreatic metastases responded to weekly paclitaxel treatment, but eventually regrew. The patient underwent distal pancreatectomy with splenectomy, left adrenalectomy, partial stomach resection, and paraaortic lymph nodes excision in December 2004 after no other metastasis was confirmed. Furthermore, she received radiation therapy for left parasternal lymph node metastasis 6 months later. The patient recovered well. Consequently, she has no evidence of disease > 15 years after pancreatectomy.ConclusionsThis is the first reported case of pancreatectomy for pancreatic metastases from breast cancer, which was simultaneously diagnosed. Patients with no metastasis other than resectable pancreatic metastases and breast cancer and who possess some sensitivity for chemotherapy may benefit from pancreatectomy.

CASE REPORT: METASTATIC PHYLLODE TUMOR

Rationale: Malignant phyllodes tumors are rare breast neoplasms that are associated with a 6.2% to 25% incidence rate of distant metastasis the lung is the most common metastatic site. To date, there is no consensus regarding the treatment of metastatic malignant phyllodes breast tumors. Patient concern: A 34-year-old woman was admitted into the gynecology department for a rapidly growing left breast tumor that was first noticed month prior. Diagnosis: Core needle biopsy revealed a malignant phyllodes tumor. A chest computed tomography tomography/CT showed metastatic lymph nodes that appeared to have spread to the right axilla She was subsequently followed by course of radiotherapy, she consulted again 3 months later for a productive cough, X-ray thorax in comparison with that made preoperatively: presence of the left peri-hilar nodules which were not present on the first X-ray Interventions: A left mastectomy with axillary lymph node dissection was conducted and a thoracoabdominal flap and a split thickness skin graft were performed for the skin defect. And radiotherapie adjuvant. Lessons: As standard treatment guidelines for metastatic malignant phyllodes tumors are lacking, we opted for the aforementioned aggressive treatments that resulted in complete remission of the lung metastasis. Therefore, aggressive treatment, whenever possible, is warranted.

FIBROADENOMA JUVENIL GIGANTE EM PACIENTE HEBIÁTRICO: RELATO DE CASO

Fibroadenoma is the most frequent breast tumor in women aged 10 to 20 years, a neoplasm characterized by a benign multiplication with rapid growth and usually in the form of a single lump. A clinical case report study was performed on a 12 year and 7 month old girl, who had a left breast tumor, occupying all its extension. When the tumor is larger than 5 cm or 500 g or when it occupies at least 80% of the breast is considered a giant juvenile fibroadenoma. The choice of tumor surgical excision is the best option for both diagnosis and treatment, due to the need for pathologic evaluation. It is a picture that needs attention, since it has the characteristic of mimicking other pathologies, besides having a very rapid evolution.

Giant primary angiosarcoma of an adolescent girl\u2019s breast diagnosed postmortem: a case report

BackgroundAngiosarcoma is an endothelial malignant tumor; angiosarcoma located in the breast is extremely rare, less than 0.01%. We report a case of a giant angiosarcoma diagnosed postmortem in a 16-year-old girl in a resource-constrained country.Case presentationA 16-year-old black African girl was admitted for altered consciousness and a left breast tumor. She was admitted in a state of apparent death. Her death was confirmed on clinical examination. A postmortem biopsy of the mammary tumor showed standard histology of a proliferation of fusiform or rounded tumor cells in places, which were not very cohesive with marked anisokaryosis and numerous foci of tumor necrosis. Immunohistochemistry showed a positivity of CD31 and factor VIII markers with a proliferation index (Ki-67) estimated at 30%.ConclusionPrimary angiosarcoma of the breast is exceptional in adolescents and has a poor prognosis, especially in countries with limited resources.

Abstract P1-21-04: Comprehensive genomic analysis of synchronous bilateral breast cancer tumors

Abstract Background: Only 1-2 % of all breast cancers present as synchronous bilateral breast cancers. These tumors may be clonally related or clonally independent. Previous analyses of synchronous bilateral breast cancers were limited by the small sample size and lack of comprehensive genomic analysis. Comparative analysis of genomic alternations in these tumors presents a unique opportunity to address the following important questions: (1) are bilateral breast cancers clonally related, and (2) do bilateral breast cancers carry molecular and genomic alterations unique from those of unilateral breast cancers. Methods: We examined synchronous left and right breast tumor samples from (16) patients collected from 1988 -1998, flash frozen, and stored at -80C in the OHSU Knight Cancer Institute BioLibrary, and 10 pairs of FFPE preserved synchronous tumors from the Kaiser Permanente NW Research Bank, collected between 2004 and 2011. These samples and matching patient demographics, clinical staging, and biomarker configuration were acquired and research conducted under IRB regulatory approval. Tumor sections were cut and tumor rich areas identified and macro-dissected. Genomic DNA was isolated and whole exon-sequencing performed. For Kaiser specimens, a benign axillary lymph node was used as a matched germ line control. Clonal relationships were determined based on distribution of somatically acquired mutations and copy number variations in the bilateral breast cancer pairs. Results: Two out of 23 synchronous bilateral breast cancers (tumors excised on the same date or within a short interval of time) are clonally related based on distribution of somatically acquired mutations and copy number variation. Two out of three metachronous bilateral breast cancers (tumors excised 6, 12 and 18 months apart) are clonally related. Each tumor of a clonally related bilateral breast pair may have a different biomarker configuration. The number of unique somatic mutations in bilateral breast cancers from four clonally related pairs, i.e. present only in tumors from one side but not the contralateral side, is small and ranges from 0 to 8. The number and distribution of somatically acquired mutations in this set of bilateral breast cancers is similar to those previously seen in unilateral breast cancers. Conclusion: To our knowledge, our study represents the largest collection of synchronous bilateral breast cancers to have received comprehensive genomic analysis. Synchronous bilateral breast cancers appear to have similar breast cancer associated mutations as have been reported with unilateral breast cancers. The molecular differences between clonally related bilateral breast cancers appears to be limited suggesting that study of these differences may reveal the molecular underpinning of breast cancer metastasis. Citation Format: Shiuh-Wen Luoh, Myron Peto, Betsy Ramsey, Carol Halsey, Timothy Butler, Paul Spellman. Comprehensive genomic analysis of synchronous bilateral breast cancer tumors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-21-04.

Metastatic Lobular Carcinoma of the Breast Presenting with Small Bowel Metastases: Case Report and Literature Review

Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no evidence of local, regional, or distant recurrence, and she is still on endocrine therapy. Discussion: The time interval between primary breast cancer and gastrointestinal involvement may range from synchronous presentation to as long as 30 years. The clinical manifestations in GI lobular breast cancer metastasis may range from non-specific complaints to acute GI symptoms, such as a bowel obstruction. There are multiple controversies in the management of ILC. Systemic treatment should be initiated as soon as possible. Indications for postmastectomy radiotherapy are also controversial, given the propensity for multifocal/multicentric tumors and late recurrences, sometimes in atypical locations. Five years of postoperative adjuvant hormonal therapy is an option for women with poor prognosis. Remissions are observed in 32% to 53% of patients. Conclusion: Metastatic lobular carcinoma of the breast has a wide range of clinical presentations. Patients with a history of breast cancer who present with new GI tumors should have these lesions evaluated for evidence of metastasis through histopathologic and immunohistochemical analysis, this will allow for appropriate management. Currently, breast cancer management involves a multidisciplinary approach including surgery, radiotherapy, and systemic medical therapy, and the treatment must be tailored to the patient’s needs.

A CASE OF TUMOR-TO-TUMOR METASTASIS OF BREAST CANCER WITHIN RENAL CELL CARCINOMA

A 76-year-old woman presented with a left chest ulcer. Computed tomography (CT) showed a 9-cm-sized invasive mass with ulceration in the left breast, along with regional lymph node and distant metastases, and a 4-cm-sized tumor at the upper pole of the left kidney. Needle biopsy of the left breast tumor was performed, and she was diagnosed with breast cancer, cT4cN3M1, Stage IV. She underwent endocrine therapy and chemotherapy. After undergoing treatment for 2 years, CT showed no progression in the primary and metastatic lesions except for increasing renal mass. Primary kidney cancer was suspected, and she underwent laparoscopic nephrectomy. In the surgical specimen, a solid, brown-colored nodule was observed in the upper pole of the left kidney. The pathological diagnosis was clear cell renal cell carcinoma, including a metastatic lesion of breast cancer. She was diagnosed with tumor-to-tumor metastasis of breast cancer within renal cell carcinoma. Two years after the surgery, no recurrence of renal cell carcinoma has been observed, and she is undergoing secondary endocrine therapy against breast cancer.

LESSONS DERIVING FROM AN EASY LAPAROSCOPIC CHOLECYSTECTOMY

Gallstone is a very frequent condition, therefore laparoscopic cholecystectomy - the gold standard in the treatment of the above mentioned pathology - is the most frequent surgical intervention performed in the surgery departments in the country and abroad. At the same time, it is the laparoscopic surgery with the highest number of intraoperative incidents and accidents. Thus, in a surgical environment dominated by the stress of injuring the main bile duct, extracting the piece and sending it for the anatomical pathology examination remains on a secondary level. This is why we would like to discuss a problem related to laparoscopic cholecystectomy which is less approached in the specialty literature. Patient B, admitted to the General Surgery and Emergency Clinic III of the University Emergency Hospital of Bucharest (UESB) – medical chart (M.C.), aged 66 with a surgical history – a simple, uncomplicated laparoscopic cholecystectomy, undergone ​​two years before, with a good postoperative evolution – came to the emergency room with diffuse abdominal pain, more pronounced on the right flank. The clinical, biological and imaging evaluation performed did not reveal any pathological aspects, except for the abdominal-pelvic CT scan with a contrast agent which revealed an expansive process in the right hypochondrium lining the costal side of the liver segment VI. The tumour was surgicaly removed; the extemporaneous histopathological examination was inconclusive about the origin of the tumoral formation (adenocarcinoma of the digestive tract ). The key to the diagnosis was obtained in an administrative manner because, when the discharge letter delivered at the time of the cholecystectomy was reviewed, the absence of the result of the anatomical pathology examination of the cholecystectomy piece was noticed. The respective clinic was contacted and the result of the anatomical pathology examination was obtained, i.e. adenocarcinoma of the gallbladder. After 3 months from the surgery the patient returned with a left breast tumor with the HP diagnosis of invasive ductal carcinoma and a total Madden mastectomy wa performed. After 5 more months, surgery was necessary again for a parietal epigastic tumor - with the anatomical pathology result of cholangiocarcinoma. The author reports the case because he believes that this is further proof of the necessity of sending any cholecystectomy piece, and broadly speaking, any excised piece, for the HP examination. Moreover the patient's attention should be drawn to the necessity of returning to the clinic to take the anatomical pathology result because this result may require the reconsideration of therapeutic conduct.

Granular cell tumor of the breast: Molecular pathology and clinical management.

Granular cell tumor is a rare condition that occasionally affects breast parenchyma: approximately, 5%-15% of all granular cell tumors represent 1:1000 of breast tumors. In this study, we reported a consecutive series of 12 patients with primary granular cell tumor of the breast observed at our institute, focusing attention on preoperative management, surgical approach, and long-term follow-up. Eight cases (8/12; 66.78%) presented with left-breast tumors; in the majority of patients (11/12; 91.7%), the lesion was identified in one of the upper quadrants. Specifically, upper intern quadrants (10 cases) were more affected. Surgical excision was performed in all patients. Mean diameter at pathologic section was 11.4 mm (range: 5-22). Tumor relapse was reported only in one case (8.3%). Mean follow-up was 98.1 months (range: 1-192). We proposed a model to explain the molecular mechanism of granular cell tumorigenesis associating to the high level of S100 protein. Management of primary granular cell tumor of the breast requires a correct initial diagnosis using breast imaging associated with core biopsy. Surgical procedure with wide resection or quadrantectomy requires a careful evaluation of breast margins.

Metaplastic breast carcinoma with extensive osseous differentiation: a report of two cases and review of the literature.

Invasive breast cancer with osseous metaplasia is rare. Here we report two cases of metaplastic breast carcinoma with extensive osseous differentiation. Case 1: The patient was a 60-year-old woman with a right breast tumor, about 4 cm in diameter. Mammogram and ultrasound presented an irregular-shaped mass suspected for malignancy. Core needle biopsy confirmed invasive carcinoma and the patient underwent a modified radical mastectomy. Case 2: The patient was a 48-year-old woman with a left breast tumor, about 3 cm in diameter. Mammogram demonstrated a well-circumscribed mass with extensive dense calcifications. Frozen section biopsy confirmed invasive carcinoma and a modified radical mastectomy was performed. The two patients had no metastatic carcinoma in the axillary lymph nodes and remained free of recurrence and systemic metastases in a 13- and 4-month follow-up period, respectively. Histopathologically, patient 1 had an adenocarcinoma with prominent sarcomatous (osteosarcomatous) differentiation with intervening spindle cells. The sarcomatous areas showed high nuclear atypia, pleomorphism and a high Ki-67 index. In Case 2, the neoplasm consisted of invasive ductal carcinoma of no special type with an osseous metaplasia component and showed a direct transition from the carcinoma to the osseous elements. The distinction between the different types of metaplastic carcinomas, specifically the distinction between benign and malignant metaplastic (osteoid) elements, should be taken into consideration.