Carcinoma medular da mama: correlação anátomo-radiológica / Medullary breast carcinoma: anatomo-radiological correlation", "_i": "en

OBJETIVO: Avaliar as características radiológicas do câncer de mama medular em pacientes submetidas atratamento cirúrgico no Instituto Nacional de Câncer (INCA) û Ministério da Saúde, Rio de Janeiro, RJ, correlacionando os achados com estudo histopatológico. MATERIAIS E MÉTODOS: Foi realizado estudo descritivo retrospectivo de mulheres submetidas a tratamento cirúrgico no INCA, no período de janeiro de 1997 adezembro de 2006, para identificação das pacientes com carcinoma medular e análise dos achados radiológicos.RESULTADOS: Foram identificadas 21.287 pacientes com diagnóstico de carcinoma neste período, sendo 76 pacientes com diagnóstico de carcinoma medular típico (0,357%). Nessas pacientes selecionadas, a idade média foi de 51,9 anos (32 a 81 anos). Dezenove pacientes apresentavam lesão na mamografia, sendo 17 (89,5%) nódulos e 2 assimetrias focais (10,5%). Entre as pacientes com nódulo, 15 (88,1%) apresentavam alta densidade e 2 eram isodensos (11,9%). Doze pacientes apresentavam achados ultra-sonográficos e, destas, 11 (91,6%) apresentavam nódulos hipoecóicos. Foi observada uma paciente com nóduloanecóico com áreas de degeneração cística. CONCLUSÃO: O nódulo foi o achado radiológico dominante (89,5%), dos quais 88,1% apresentaram nódulos com alta densidade e margens circunscritas. Apesar das características radiológicas de benignidade, um nódulo com alta densidade, sólido, margens circunscritas e crescimento rápido deve ser investigado para confirmar o diagnóstico.

OBJECTIVE: To evaluate radiological findings in patients submitted to surgical treatment for medullary breast cancer at Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil, correlating them with histological results. MATERIALS AND METHODS: A retrospective descriptive study was developed with patients submitted to surgery at INCA, in the period from January 1997 to December 2006, for identifying the presence of medullary breast carcinoma and analyzing radiological findings. RESULTS: Among 21,287 patients diagnosed with carcinoma, 76 (0.357%) had typical medullary breast carcinoma. The age range of these patients was 32û81 years (mean = 59.1 years). Mammography demonstrated lesions in 19 of these patients, 17 (89.5%) of them with masses, and 2 with focal asymmetry. Among the patients with masses, 15 (88.1%) presented with high density and 2 (11.9%) with isodensity. Twelve patients presented sonographic findings, 11 (91.6%) of them with hypoechoic masses, and one with an anechoic mass with areas of cystic degeneration. CONCLUSION: Nodular mass was the predominant radiological finding (89.5%), 88.1% of them corresponding to masses with high density and circumscribed margins. Despite the radiological characteristics of benignity, a solid, fastgrowing, highly dense mass with circumscribed margins should be further investigated to confirm the diagnosis.

Medullary Carcinoma of the Breast Reclassification by Ridolfi's criteria

PURPOSE: A medullary carcinoma of the breast (MC) is a rare disease that hae a better prognosis than an infiltrating ductal carcinoma of no special type. An MC creates diagnostic difficulties, and there are numerous controversies associated with the histopathological definition of this special type of breast cancer. Among many criteria, Ridolfi's criteria seems to be the strictest and to give a more reliable prognosis. METHODS: We analyzed 2,953 primary breast carcinomas treated between Jan. 1981 and Jan. 2000. Thirty-seven patients previously defined as having an MC were reclassified by one pathologist using Ridolfi's criteria. The mean follow-up period was 62.7 months (range: 4 to 162 months), and hospital records were reviewed retrospectively for clinical information. RESULTS: Of the 37 treated patients, 24 (64.9%) were reclassified as having a typical medullary carcinoma (TMC), 6 (16.2%) as having an typical medullary carcinoma, and 7 (18.9%) as having a non-medullary carcinoma (NMC). The diagnostic conversion rate was, 37.8% and 10 of 30 patients (33.3%) previously diagnosed with TMC were reclassified into other forms. TMC had the least chance and NMC had the highest chance for lymph-node metastasis, and this difference was marginally significant (p=0.069). TMC showed a better 10-year overall survival rate (p=0.01) and 10-year disease-free survival rate (p=0.09) than NMC. CONCLUSION: TMC has the least chance of lymph-node metastasis, and the best prognosis in MC. Because of the relatively high diagnostic conversion rate, physician should be careful about omitting adjuvant therapy for TMC.

Comparison of the Prognostic Factors between Medullary Cancer and an Infiltrating Ductal Carcinoma in the Breast

PURPOSE: A medullary carcinoma of the breast (MC) is a well-circumscribed tumor composed of poorly differentiated cells growing in a syncytium with an accompanying stroma. However, the prognosis of a MC is considered as more favorable than that of an infiltrating ductal carcinoma (IDC). In the present study, we characterized MC in terms of prognosis by comparing a MC group with an IDC control group. We describe the distribution of other clinicopathological characteristics, as well as the prevalence and the prognostic importance of generally well known risk factors, for breast cancer and compare the results. METHODS: Clinical data from hospital records and pathological materials were available from 60 patients with tumors that had been initially diagnosed from Jan. 1981 to Dec. 1999 at the Department of Surgery in Seoul National University Hospital as having a MC. We analyzed the survival and the prognostic factors of those patients and compared the results with those for an IDC control group. RESULTS: The 60 cases of MC showed more risk factors, such as young age, high nuclear grade, poor histologic grade, negative hormone receptors, p53 overexpression, c-erb-B2 expression, and high proliferative index (Ki 67), than the IDC cases did. However, the prognosis of MC was better than that of IDC. Most of the risk factors were of highly significant prognostic importance in the IDC control group. In the MC group, only lymph-node status and young age were significantly important for disease-free survival. CONCLUSION: We found MC to be biologically unique, and patients with MC have a better prognosis than those with IDC. We propose that MC patients with axillary lymph-node metastasis and young age be considered as a high-risk group for recurrence.

A Clinicopathologic Analysis of Medullary Breast Cancer / 대한암학회지

PURPOSE: Medullary carcinoma of breast was known to have a better prognosis than other breast cancer, but the histopathological definition of medullary carcinoma has varied with time. This study was performed to clarify the clinicopathologic features of medullary breast cancer. MATERIALS AND METHODS: Twenty cases of breast cancer originally were diagnosed as medullary carcinoma at the Department of Surgery, Seoul National University Hospital from Jan. 1985 to Jun. 1995. The whole cases were reviewed and reclassified using the strictly defined histologic criteria applied by Ridolfi et al. RESULTS: When reclassified, 16 tumors fulfilled the criteria of typical medullary cancer. But the rest 4 tumors were found to be nonmedullary cancer. The patients ranged from 29 to 69 years in age with an average of 49. The main symptom was the painless mass. The diameter of the tumor ranged from 1 to 8 cm with a mean size of 2.7 cm. The axillary lymph node was positive in three cases. The estrogen receptor was positive in 10%, and the progesterone receptor was positive in 20% of the cases. There were no local recurrences or distant metastasis during a mean follow-up period of 5.5 years.. All patients survived until the last follow-up. CONCLUSION: Medullary breast cancer has good prognosis but strict, uniform histopathological diagnostic criteria are needed.