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Coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts: case report
Guerino Neto, Claudia Rossetti, Natalia A Souza, Fernando LA Fonseca, Ligia Azzalis, Virginia Berlanga Junqueira, Vitor E Valenti, Luiz de Abreu
European Journal of Medical Research , 2012, DOI: 10.1186/2047-783x-17-8
Abstract: Phyllodes tumors represent a rare biphasic neoplasm composed of epithelial and stromal elements, which corresponds to a total of 1% of breast cancers and around 2% to 3% of fibroepithelial tumors [1,2]. The concomitance of these tumors with epithelial malignant neoplasms is rare. The literature reported the association of phyllodes tumors with malignant epithelial components mainly in the form of ductal or lobular in situ lesions and less often in the invasive form. However, they are usually situated inside the lesion or near the fibroepithelial neoplasm tissue [3].Treatment of these tumors depends on the epithelial and fibroepithelial lesion intrinsic profile. Excision of the lesion with margins is considered to be adequate in benign phyllodes tumors cases. On the other hand, when the phyllodes tumors are large, a simple mastectomy is recommended. In the case of epithelial injury, size, location and lymph node involvement are not considered in determining therapeutic approaches [3-5].Carcinoma is the medical term for the most common type of cancer occurring in humans [6-8]. The synchronous coexistence of benign phyllodes tumor in one breast and invasive carcinoma in the other breast is rare. In fact, we found no reports in the literature documenting the association of phyllodes tumor and invasive ductal carcinoma. To our knowledge, this is the first report to describe a case of synchronous coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts.This is a 66-year-old patient, with four pregnancies, three normal deliveries and one abortion. She smoked from the ages of 10 to 51?years and had no family history of breast carcinoma. She reported the presence of progressively growing nodules in both breasts in 2005. In 2006, she underwent a mammography (Figure 1) with suspicious findings and was referred to the hospital. She did not visit the hospital for fear of a positive diagnosis. In December 2006, she underwent another mammography, and
The clinical behavior of mixed ductal/lobular carcinoma of the breast: a clinicopathologic analysis
Aparna Suryadevara, Lakshmi P Paruchuri, Nassim Banisaeed, Gary Dunnington, Krishna A Rao
World Journal of Surgical Oncology , 2010, DOI: 10.1186/1477-7819-8-51
Abstract: In this paper, we present a clinicopathologic analysis of patients at our institution with this entity and compare them to age-matched controls with purely invasive ductal carcinoma (IDC) and historical data from patients with purely lobular carcinoma and also stain-available tumor specimens for E-cadherin. We have obtained 100 cases of ductal and 50 cases of mixed ductal/lobular breast carcinoma.Clinically, the behavior of mixed ductal/lobular tumors seemed to demonstrate some important differences from their ductal counterparts, particularly a lower rate of metastatic spread but with a much higher rate of second primary breast cancers.Our data suggests that mixed ductal/lobular carcinomas are a distinct clinicopathologic entity incorporating some features of both lobular and ductal carcinomas and representing a pleomorphic variant of IDC.Infiltrating ductal carcinoma is the most common type of invasive breast cancer, accounting for 65% to 80% of invasive breast lesions[1,2]. Its characteristics have been well described, including average age of onset, its rate of hormone receptor and erbB2 positivity, frequency of nodal involvement, rates of metastatic spread, and overall survival[3]. Historically, invasive lobular carcinomas (ILC) represented the second most common subtype of mammary neoplasia, accounting for about 5% to 10% of the disease[4]. The clinical behavior of ILC has been known to be different since its recognition as a distinct clinicopathologic entity[5]. Lobular carcinomas that are more frequently hormone-receptor positive[6] display a higher incidence of synchronous, contralateral primary tumors[7], more frequently present with multicentric disease[8], and metastasize to distinct sites such as the meninges, serosa, and retroperitoneum[9]. Given the difference in behavior between the two subtypes and the unique behavior of the ILC, the initial diagnostic workup has often involved the use of bilateral breast MRI to assess the state of the contralateral
Malignant phyllodes tumor with heterologous liposarcomatous differentiation and tubular adenoma-like epithelial component  [cached]
L. Uriev, I. Maslovsky, P. Vainshtein, B. Yoffe, D. Ben-Dor
International Journal of Medical Sciences , 2006,
Abstract: Phyllodes tumor of the breast is a biphasic fibroepithelial neoplasm. A 30-year-old woman presented with a 1-year history of a palpable, asymptomatic right breast mass without axillary lymphadenopathy and family history of breast carcinoma. Malignant phyllodes tumor was diagnosed. The authors present not previously described histological appearance of this tumor where an epithelial component was identical to that of a tubular adenoma of the breast, with the review of the literature. This is in addition to very rare liposarcomatous stromal differentiation in the malignant phyllodes tumor.
Malignant phyllodes tumor in the right breast and invasive lobular carcinoma within fibroadenoma in the other: case report
Gebrim, Luiz Henrique;Bernardes Júnior, Júlio Roberto de Macedo;Nazário, Afonso Celso Pinto;Kemp, Cláudio;Lima, Geraldo Rodrigues de;
Sao Paulo Medical Journal , 2000, DOI: 10.1590/S1516-31802000000200004
Abstract: context: the malignant variety of the phyllodes tumor is rare. the occurrence of invasive lobular carcinoma within fibroadenoma is rare as well. design: case report. case report: a 58-year-old black female patient was referred to the mastology unit of the department of gynecology, federal university of s?o paulo / escola paulista de medicina, in february 1990, presenting an ulcerated tumor in the right breast with fast growth over the preceding six months. she was a virgin, with meno-pause at the age of 45 years and had not undergone hormone replacement treatment. the physical examination showed, in her right breast, an ulcerated tumor of 20 x 30 cm which was not adher-ent to the muscle level, multilobular and with fibroelastic consistency. the axillary lymph nodes were not palpable. the left breast showed a 2 x 3 cm painless, movable nodule, with well-defined edges, and fibroelastic consistency. we performed left-breast mammography, which showed several nodules with well-defined edges, the largest being 2 x 3 cm and exhibiting rough calcification and grouped microcalcifications within it. the patient underwent a frozen biopsy that showed a malignant variant of the phyllodes tumor in the right breast and fibroadenoma in the left one. after that, we performed a total mastectomy in the right breast and an excision biopsy in the left one. paraffin study confirmed the frozen biopsy result from the right breast, yet we observed that in the interior of the fibroadenoma that was removed on the left, there was a focal area of invasive lobular carcinoma measuring 0.4 cm. the patient then underwent a modi-fied radical mastectomy with total axillary lymphadenectomy. none of the 21 dissected lymph nodes showed evidence of metastasis. in the follow-up, the patient evolved asymptomatically and with normal physical and laboratory examination results up to july 1997.
A Case Report: Lobular Carcinoma In Situ in a Male Patient with Subsequent Invasive Ductal Carcinoma Identified on Screening Breast MRI  [cached]
Linda Kao, Yekaterina Bulkin, Susan Fineberg, Leslie Montgomery, Tova Koenigsberg
Journal of Cancer , 2012,
Abstract: Lobular carcinoma in situ is a form of in situ neoplasia that develops within the terminal lobules of the breast. It is an extremely rare finding in males due to the lack of lobular development in the male breast. The authors herein report an unusual case of incidentally discovered lobular carcinoma in situ in a male patient with recurrent bilateral gynecomastia who was subsequently diagnosed with invasive ductal carcinoma of the left breast. The pathology of lobular carcinoma in situ in a male as well as screening MRI surveillance of male patients at high risk for breast cancer are discussed, emphasizing the importance of screening and imaging follow up in men who are at high risk for breast cancer.
Relevance of systems biological approach in the differential diagnosis of invasive lobular carcinoma & invasive ductal carcinoma  [cached]
PK Ragunath,B Vanaja Reddy,PA Abhinand,Shiek SSJ Ahmed
Bioinformation , 2012,
Abstract: Breast cancer is a malignant neoplasm originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. ILCs and IDCs vary from each other with respect to various histological, biological and clinical features. Remarkably, ductal tumors tending to form glandular structures, whereas lobular tumors are less cohesive and tends to invade in single file. The high degree of similarity in the prognoses of IDC and ILC makes it beneficial to develop a differential diagnostic protocol to classify the two conditions. The main goal of the study is to construct the genetic regulatory network from the microarray data using biological knowledge and constraint-based inferences, in order to explore the potential significant gene regulatory networks that can differentiate IDC and ILC and thereby understand the complex interactions that are influenced by the genetic networks. Out of the 54676 genes present on the GPL570 platform- 29 genes exhibited 4 fold up regulation in case of IDC and 22 in the case of ILC. The ductal and lobular tumors displayed a striking difference in the expression of genes associated with cell adhesion, protein folding, and protein phosphorylation and invasion. Construction of separate gene regulation networks for IDC and ILC on the basis of gene expression altercation can be utilized in understanding the distinction in the possible mechanism that underlies the pathological differences between the two, which can be exploited in identifying diagnostic or therapeutic targets.
Tumor characteristics and the clinical outcome of invasive lobular carcinoma compared to infiltrating ductal carcinoma in a Chinese population
A-Yong Cao, Liang Huang, Jiong Wu, Jin-Song Lu, Guang-Yu Liu, Zhen-Zhou Shen, Zhi-Ming Shao, Gen-Hong Di
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-152
Abstract: Clinicopathologic features, overall survival (OS), and recurrence/metastasis-free survival (RFS) were compared between 2,202 patients with IDC and 215 patients with ILC.ILC was significantly more likely to be associated with a favorable phenotype, but the incidence of contralateral breast cancer was higher for ILC patients than for IDC patients (8.4% vs. 3.9%; P =0.001). The frequencies of recurrence/metastasis (P?=?0.980) and death (P?=?0.064) were similar among patients with IDC and patients with ILC after adjustment for tumor size and nodal status. The median follow-up was 42.8 months.Chinese women with ILCs do not have better clinical outcomes than their counterparts with IDC. Management decisions should be based on individual patient and tumor biologic characteristics, and not on lobular histology.
Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma
James W Horvath, Gary E Barnett, Rafael E Jimenez, Donn C Young, Stephen P Povoski
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-34
Abstract: We evaluated the results of 131 consecutive cases of ILC from 1997 to 2008 and 133 cases of IDC (selected by a random sequence generator program) from amongst 1163 consecutive cases of IDC from the same time period. All cases had at least one SLN that had both intraoperative frozen section analysis and confirmatory permanent section analysis performed.No statistically significant difference was found in the sensitivity (67% vs. 75%, P = 0.385), specificity (100% vs. 100%), accuracy (86% vs. 92%, P = 0.172), false negative rate (33% vs. 25%, P = 0.385), negative predictive value (81% vs. 89%, P = 0.158), and positive predictive value (100% vs. 100%) for frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC.Since there was no statistically significant difference in sensitivity, specificity, accuracy, false negative rate, negative predictive value, and positive predictive value between frozen section analysis of SLNs for patients with ILC and IDC, the clinical accuracy of confirming metastatic involvement of SLNs on frozen section analysis for ILC should not be considered inferior to the clinical accuracy for IDC. Therefore, frozen section analysis of all SLNs during breast cancer surgery in patients with ILC should remain the standard of care in order to reduce the risk of the need of a later, separate axillary lymph node dissection.Sentinel lymph node (SLN) biopsy with intraoperative frozen section analysis has become a standard of care in the surgical staging of the axilla during breast cancer surgery [1-3]. The sensitivity of intraoperative frozen section analysis for identifying nodal metastases within SLNs during breast cancer surgery has been reported to vary widely from the range of 44% to 95% [4-17], with most series reporting the sensitivity of frozen section analysis in the range of 60% to 75% [5,7-9,11-13,15-17].The difficulty with identifying nodal metastases from invasive lobular
Comparison of the Subgross Distribution of the Lesions in Invasive Ductal and Lobular Carcinomas of the Breast: A Large-Format Histology Study  [PDF]
Syster Hofmeyer,Gyula Pekár,Mária Gere,Miklós Tarján,Dan Hellberg,Tibor Tot
International Journal of Breast Cancer , 2012, DOI: 10.1155/2012/436141
Abstract: To compare the lesion distribution and the extent of the disease in ductal and lobular carcinomas of the breast, we studied 586 ductal and 133 lobular consecutive cancers. All cases were documented on large-format histology slides. The invasive component of ductal carcinomas was unifocal in 63.3% (371/586), multifocal in 35.5% (208/586), and diffuse in 1.2% (7/586) of the cases. The corresponding figures in the lobular group were 27.8% (37/133), 45.9% (61/586), and 26.3% (35/133), respectively. When the distribution of the in situ and invasive component in the same tumors was combined to give an aggregate pattern, the ductal carcinomas were unifocal in 41.6% (244/586), multifocal in 31.6% (185/586), and diffuse in 26.8% (157/586) of the cases. The corresponding figures in the lobular category were 15.0% (20/133), 54.2% (72/133), and 30.8% (41/133), respectively. Ductal cancers were extensive in 45.7% (268/586), lobular in 65.4% (87/133) of the cases. All these differences were statistically highly significant ( ). While the histological tumor type itself (ductal versus lobular) did not influence the lymph node status, multifocal and diffuse distribution of the lesions were associated with significantly increased risk of lymph node metastases in both ductal and lobular cancers. 1. Introduction Breast cancer is a heterogeneous disease in which the individual cases deviate from each other in morphology, protein expression, molecular phenotype, genetic characteristics, and prognosis. Breast carcinomas of “special-types” have been delineated based on their microscopical characteristics, but the vast majority of tumors belongs to the category of not otherwise specified (NOS) ductal carcinomas. Invasive lobular carcinomas represent the most frequent “special-type” breast carcinoma and comprise 5–15% of all breast cancer cases [1]. In addition both the ductal and the lobular tumors also represent heterogeneous groups of diseases and can be prognostically stratified with grading or delineating distinct histological subtypes. Numerous studies have compared ductal and lobular breast carcinomas using different criteria, and reported more [2, 3] or less favourable [4, 5] outcome in lobular compared to ductal carcinomas, or no significant differences in outcome [6, 7]. On the other hand, studies on subgross morphology (lesion distribution and disease extent) of these tumors are very rare. Tot has previously described the diffuse variant of invasive lobular carcinoma and reported a poorer prognosis when compared to unifocal and multifocal lobular cancers [8]. Foschini
Unusual Metastatic Patterns of Invasive Lobular Carcinoma of the Breast  [PDF]
Justin D. Sobinsky,Thomas D. Willson,Francis J. Podbielski,Mark M. Connolly
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/986517
Abstract: Invasive lobular carcinoma of the breast has similar patterns of metastatic disease when compared to invasive ductal carcinoma; however, lobular carcinoma metastasizes to unusual sites more frequently. We present a 65-year-old female with a history of invasive lobular breast carcinoma (T3N3M0) treated with modified radical mastectomy and aromatase-inhibitor therapy who underwent a surveillance PET scan, which showed possible sigmoid cancer. Colonoscopy with biopsy revealed a 3?cm sigmoid adenocarcinoma. The patient underwent a lower anterior resection. Pathology showed an ulcerated, invasive moderately differentiated adenocarcinoma extending into but not through the muscularis propria. However, six of seventeen paracolonic lymph nodes were positive for metastatic breast carcinoma (ER+/PR+), consistent with her lobular primary breast carcinoma; there was no evidence of metastatic colon cancer. This case highlights the unusual metastatic patterns of lobular carcinoma. 1. Case and Surgical Treatment A 65-year-old female with a history of invasive lobular breast carcinoma (T3N3M0) treated with modified radical mastectomy and aromatase-inhibitor therapy underwent a surveillance PET scan approximately three years later, which showed possible sigmoid cancer (Figure 4). The patient was referred to gastroenterology; a colonoscopy with biopsy revealed a 3 cm sigmoid adenocarcinoma. The patient underwent a lower anterior resection. Pathology showed an ulcerated, invasive moderately differentiated adenocarcinoma extending into but not through the muscularis propria (Figure 2). However, six of seventeen paracolonic lymph nodes were positive for metastatic breast carcinoma (ER+/PR+), consistent with her lobular primary breast carcinoma (Figure 1); there was no evidence of metastatic colon cancer (Figure 3). Figure 1: Primary lobular carcinoma. Figure 2: Primary colon adenocarcinoma. Figure 3: Pericolonic lymph node with positive mammaglobin staining. Figure 4: PET CT scan with avid FDG uptake associated with the sigmoid colon. Hematology/oncology was consulted regarding her metastatic invasive lobular breast carcinoma. They discontinued her tamoxifen and started her on Arimidex. The patient had a recent PET scan, which showed no signs of recurrent disease. 2. Discussion One in twelve American women develop breast cancer, and infiltrating lobular carcinoma (ILC) involves around 10% of these cases [1]. When comparing ILC to infiltrating ductal carcinoma (IDC), the sites of metastatic spread differ. In IDC, the common sites of metastatic disease are seen in the lung,
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