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MALIGNANCY IN BREAST LUMPS
M. MUTTAHHAR ASIM NIAZ
The Professional Medical Journal , 2007,
Abstract: Objective:(i) To assess the frequency ofmalignancy in patients presenting with breast lumps. (ii)To find the age related frequency of malignancy in these cases.Design Observational study. Setting: Department of General Surgery, Combined Military Hospital Lahore. Period:From Jan 1998 and Jan 2000. Patients and methods: All patients presenting with breast lumps were included in thestudy. All patients had FNAC of the lump. Patients with signs or suspicion of malignancy were subjected to core needleor excisional biopsy and pathologic diagnosis confirmed. Cases proven malignant on FNAC and showing signs ofmalignancy under went mastectomy, followed by histopathological diagnosis. Non-diagnostic smears were repeatedor subjected to biopsy of the lesion. Cases of suspicious smears also underwent biopsy for histopathological diagnosis.Results: 277 patients with breast lumps managed at CMH Lahore were studied. 24.2% were diagnosed as having amalignant lump. Mean age in the present study is 32.96yrs for benign and 51.81yrs for malignant breast lumps.Conclusions: Frequency of breast cancer in breast lumps was 24.2% in the total cases in the study, almost one in 4female patients coming to a surgical clinic with breast lumps can have a malignant breast lump. Breast cancerfrequency is negligible under the age of 30 yrs. The probability of diagnosing of a breast lumps as malignant is 1 in 3in 31-40 yrs age group, 2 in 5 in 41-50 yrs age group, and more than 1 in 2 thereafter. There is a greater frequencyin younger age group in the population in our study as compared to international studies.
Multiple intraductal papillomas of breast clinically masquerading as malignancy  [cached]
Singh Pallavi,Misra Vatsala,Singh Premala,Mehrotra Ravi
Indian Journal of Pathology and Microbiology , 2010,
Abstract: Background: Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. Case Report: A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8× 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. Conclusion: The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.
Arterial Microcalcifications in the Breast Mimicking Malignancy
Katrin Janzen,Jan Janzen
Case Reports in Radiology , 2012, DOI: 10.1155/2012/946317
Abstract: Microcalcifications in the breast are highly suggestive of malignancy; they can occur in many pathological conditions. A 36-years-old nondiabetic woman came to the gynaecologist with a suspect palpable mass in the upper outer quadrant of the right breast. Histopathological examination confirmed a calcification of a small artery (diameter: 0.45 mm). Arterial calcifications can mimic a malignant lesion in the breast.
Prediction of outcome after diagnosis of metachronous contralateral breast cancer
Sara Alkner, P?r-Ola Bendahl, M?rten Fern?, Jonas Manjer, Lisa Rydén
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-114
Abstract: Information on patient-, tumour-, treatment-characteristics, and outcome was abstracted from patients' individual charts for all patients diagnosed with metachronous CBC in the Southern Healthcare Region of Sweden from 1977-2007. Distant disease-free survival (DDFS) and risk of distant metastases were primary endpoints.The cohort included 723 patients with metachronous contralateral breast cancer as primary breast cancer event. Patients with less than three years to BC2 had a significantly impaired DDFS (p = 0.01), and in sub-group analysis, this effect was seen primarily in patients aged <50. By logistic regression analysis, patients diagnosed with BC2 within routine follow-up examinations had a significantly lower risk of developing metastases compared to those who were symptomatic at diagnosis (p < 0.0001). Chemotherapy given after breast BC1 was a negative prognostic factor for DDFS, whereas endocrine treatment and radiotherapy given after BC2 improved DDFS.In a large cohort of patients with CBC, we found the time interval to BC2 to be a strong prognostic factor for DDFS in young women and mode of detection to be related to risk of distant metastases. Future studies of tumour biology of BC2 in relation to prognostic factors found in the present study can hopefully provide biological explanations to these findings.Within their lifetime, 2-20% of breast cancer patients develop a new tumour in their contralateral breast [1-3]. These contralateral breast cancers (CBC) are called synchronous if the second tumour (BC2) develops within a short time interval from the first tumour (BC1), and metachronous if the time interval between tumours is longer. In line with several previous studies, we define metachronous tumours as CBC diagnosed at least three months after BC1 [3-5]. However, a clear cut-off time is not defined in the literature. CBC is today treated as a new primary tumour (two individual tumours), but the biological relationship between BC1 and BC2, and the imp
Arterial Microcalcifications in the Breast Mimicking Malignancy  [PDF]
Katrin Janzen,Jan Janzen
Case Reports in Radiology , 2012, DOI: 10.1155/2012/946317
Abstract: Microcalcifications in the breast are highly suggestive of malignancy; they can occur in many pathological conditions. A 36-years-old nondiabetic woman came to the gynaecologist with a suspect palpable mass in the upper outer quadrant of the right breast. Histopathological examination confirmed a calcification of a small artery (diameter: 0.45?mm). Arterial calcifications can mimic a malignant lesion in the breast. 1. Introduction Vascular calcifications as a form of crystallization are reflecting a complex biological mechanism. Calcifications can occur in many pathological conditions, for instance, in toxic injuries and in long-term treatment with corticosteroids. Furthermore, cell death in apoptosis and mitochondrial vesicles can be responsible for calcifications. Recent studies are focusing on the inhibition effect of Matrix-Gla protein [1]. 2. Case Presentation A 36-years-old nondiabetic woman came to the gynaecologist with a suspect palpable mass (1.5?cm in diameter) in the upper outer quadrant of the right breast. Radiologically, unclear groups of microcalcifications were detected in the mammogram (Figure 1). Three stereotactic 11-gauge vacuum-assisted breast biopsies were performed. Microscopically, fragmented breast biopsies with a total length of 6.0?cm were examined. Typical aspects of lobular hyperplasia characterised by enlarged and hypercellular lobules were found. In the adjacent stroma rare mononuclear inflammatory infiltrates and small fibrotic foci were localised. Furthermore a small muscular-type artery with circumferentially arranged smooth muscle cells in the tunica media was removed. Intimal and adventitial layers of the artery showed no pathological changes. However, in the tunica media amorphous deposits—stained blue and violet in hematoxylin-eosin—were observed. These microcalcifications had a diameter of 0.45?mm. Figure 1: Radiologic aspects presenting small microcalcifications (a, b). Our case showed typical aspects of calcifications in a muscular type artery, where calcifications develop alongside the internal elastic membrane [2]. Microcalcifications were removed by biopsies in toto. There were no signs of malignancy. Arterial calcifications frequently occur in elderly people (senile medial calcinosis, Moenckeberg’s medial sclerosis) [3]. Diabetes mellitus and hyperlipidaemia have been reported with high prevalence in young and middle-aged woman with breast arterial calcifications [4]. It is well known that microcalcifications in the breast are highly suggestive of malignancy. Uncertain calcifications should indicate a
Successfully treated synchronous double malignancy of the breast and esophagus: a case report
Abhishek Singh, Ishwar Khare, Awadhesh Dixit, Kailash Pandey, Deepak Mittal, Parul Singh
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-169
Abstract: We report an extremely rare case of a 55-year-old Indian woman who had carcinomas in both the esophagus and the breast simultaneously. She was treated successfully using combined modalities of surgery, chemotherapy and radiation therapy.Cases of synchronous double malignancies can be treated by dealing with the malignancy in the two sites as independent carcinomas. We have to take into consideration the total dose of radiation to a critical organ as well as the effect of the total dose of toxic chemotherapeutic drugs on our patient.The incidence of double malignancy is very low, as is a case of synchronous breast and esophageal carcinomas. Double malignancy cases pose the problem of finding the best treatment for the patient. We present such a case which was treated successfully.A 55-year-old Indian woman reported to the hospital with complaints of dysphagia for solid foods for more than one year which had progressively increased in severity. At presentation, she had also developed difficulty in swallowing liquids and had a history of regurgitation of food after meals. There was no history of cough or difficulty in breathing during meals, thus ruling out the possibility of a tracheoesophageal fistula.A thorough physical examination revealed a lump in the left breast of approximately 3 × 3 cm in size. The lump was hard in consistency with irregular margins, and it was not fixed to the skin or to underlying structures. Two firm, mobile ipsilateral axillary lymph nodes with mild tenderness could be palpated. Our patient did not have any family history of breast or ovarian carcinoma. She had breastfed all three of her children and had been postmenopausal for eight years. There was also no history of oral contraceptive pills or hormone replacement therapy.Upper gastrointestinal endoscopy revealed a friable, ulceronodular lesion at the gastroesophageal junction involving the juxta-esophageal fundus. Endoscopic biopsy of the lesion was carried out. Histopathological examin
A case of Synchronous Malignancy of Stomach and Kidney  [PDF]
S SM Aslam,H Sridhar,MY Rao
Kathmandu University Medical Journal , 2013, DOI: 10.3126/kumj.v11i1.11053
Abstract: The synchronous occurrence of primary renal cell carcinoma with gastric cancer is very rare. We report a case of 41 year old male who presented on 05/07/2011 to M S Ramaiah hospital, Bangalore with history of fever, pain abdomen and malena. Ultrasound abdomen and pelvis showed large heterogenous mass arising from the upper pole of left kidney. Computed tomography of the abdomen showed left renal cell carcinoma. Renal biopsy showed features consistent with renal cell carcinoma – clear cell type. Oesophagogastroduodenoscopy revealed gastric polypoidal growth. Gastric biopsy from the growth revealed poorly differentiated adenocarcinoma of stomach. We report this case to highlight a rare occurrence of synchronous malignancy of stomach and kidney. DOI: http://dx.doi.org/10.3126/kumj.v11i1.11053 Kathmandu University Medical Journal Vol.11(1) 2013: 94-95
Fibromatosis (desmoid tumor) of the breast mimicking a case of ipsilateral metachronous breast cancer
Stephen P Povoski, Rafael E Jimenez
World Journal of Surgical Oncology , 2006, DOI: 10.1186/1477-7819-4-57
Abstract: We report a case of a 70 year old patient with a remote history of invasive breast cancer (treated twelve years earlier by lumpectomy, axillary lymph node dissection, postoperative radiation therapy, and five years of tamoxifen) who developed fibromatosis within another quadrant of the same breast that clinically, mammographically, and sonographically mimicked that of the development of an ipsilateral metachronous breast cancer. After the initial diagnosis of fibromatosis was made on a minimally invasive ultrasound guided biopsy, it was successfully treated by wide local excision.After appropriate recognition, wide local excision can be the appropriate surgical management strategy for fibromatosis of the breast.Fibromatosis or desmoid tumor of the breast is an extremely rare entity. Multiple case reports have been published [1-22], as well as a few comprehensive series [23-27]. Some have suggested that this entity arises de novo from within the breast parenchyma itself [13,23,24], while others have suggested that it arises de novo from the aponeurosis overlying the pectoralis major muscle [13,24,28]. Still others contend that it may arise secondary to a previous history of breast surgery or trauma [5,6,25,28]. Despite its lack of metastatic potential, fibromatosis can grow aggressively in a locally infiltrating pattern [24,29-31]. The failure to recognize this process as a finite entity within the breast and the temptation to discount it as "scar tissue" from a previous breast biopsy or trauma may ultimately lead to local recurrence within the breast if inadequately treated [22].This case report describes a patient with a remote history of breast cancer that was treated twelve years earlier by lumpectomy, axillary lymph node dissection, postoperative radiation therapy, and five years of tamoxifen who developed a case of fibromatosis within another quadrant of the same breast that clinically, mammographically, and sonographically mimicked that of an ipsilateral metac
Radiation dose to contra lateral breast during treatment of breast malignancy by radiotherapy  [cached]
Chougule Arun
Journal of Cancer Research and Therapeutics , 2007,
Abstract: Aims: External beam radiotherapy is being used regularly to treat the breast malignancy postoperatively. The contribution of collimator leakage and scatter radiation dose to contralateral breast is of concern because of high radio sensitivity of breast tissue for carcinogenesis. This becomes more important when the treated cancer breast patient is younger than 45 years and therefore the contralateral breast must be treated as organ at risk. Quantification of contralateral dose during primary breast irradiation is helpful to estimate the risk of radiation induced secondary breast malignancy. Materials and Methods: In present study contralateral breast dose was measured in 30 cancer breast patients undergoing external beam therapy by Co-60 teletherapy machine. Postoperative radiotherapy was delivered by medial and lateral tangential fields on alternate days in addition to supraclavicle field daily with 200 cGy/F to a total dose of 5000 cGy in 25 fractions. CaSO4: Dy themoluminescence dosimeter discs were employed for these measurements. Three TLD discs were put on the surface of skin of contra lateral breast, one at the level of nipple and two at 3 cms away from nipple on both side along the midline for each field. At the end treatment of each filed, TLD discs were removed and measured for dose after 24h on Thelmador - 6000 TLD reader. Results: The dose at the contra lateral breast nipple was to be 152.5 to 254.75 cGy for total primary breast dose of 5000 cGy in 25 equal fractions which amounted to 3.05-6.05% of total dose to diseased breast. Further it was observed that the maximum contribution of contralateral breast dose was due to medical tangential half blocked field. Conclusion: CaSO4; Dy thermoluminescence dosimetry is quite easy, accurate and convenient method to measure the contra lateral breast dose.
Male breast malignancy in Jos University Teaching Hospital
AT Kidmas, BT Ugwu, AN Manasseh, D Iya, AS Opaluwa
West African Journal of Medicine , 2005,
Abstract: Background: Male breast malignancies are rare. Cancer of the male breast accounts for about 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. Patients and Methods: A retrospective study of all cases of male breast cancer (MBC) managed in Jos University Teaching Hospital over a 17-year period (January 1987-December 2003.) Results: A total of 302 cases of breast malignancies were managed over the study period. Twenty-six (8.6%) of these were males giving a male:female ratio of 1:10.6. The ages of the 26 MBC cases ranged from 12 years to 85 years, with a mean of 57.9 years and median age of 67 years. The right breast was affected in 15 and the left in 11. Mean duration of symptoms before presentation was 6 months with a range of 3 months to 4 years. All the patients had history of breast lumps, 21 (80.8%) of which were painless. Skin ulceration and axillary node enlargement were present in 19(73.1%) and 24(92.3%) respectively. Five (19.2%) were stage II; 15(57.7%) stage III and 6(23.1%) stage IV. There were 23 (88.5%) carcinomas, 2 (7.7%) fibrosarcomas and a case of Hodgkin's lymphoma. Invasive ductal carcinoma was the most common histological type in 20 (76.9%) of all breast malignancy and 20 (87.0%) of all breast carcinomas. Modified radical mastectomy (mastectomy with axillary clearance with or without division of the pectoralis minor muscle) was done in 10(38.5%) patients. Two of these were fibrosarcomas. Simple mastectomy was done in 13 (50%) as toilet procedures for advanced disease. The only case of Hodgkin's lymphoma had chemotherapy. Bilateral orchidectomy (BO), Tamoxifen, chemotherapy and radiotherapy were offered in 7(26.9%), 13(50%), 17(65.4%) and 7(26.9%) patients respectively. Wound infection was the most common complication in 14(53.8%) patients. There was no case of hospital mortality. Conclusion: MBC accounts for 8.6% of all breast cancers in our centre. It affects elderly males. Late presentation with advanced disease and ulceration is a common feature in our environment.
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