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RESUMEN Introducción: El cáncer de mama se conoce desde épocas remotas, el tumor de mama es la neoplasia maligna más importante en la mujer. Se considera la primera causa de muerte por cáncer en las mujeres en el mundo. Objetivo: Evaluar la correlación ecográfica, mamográfica e histopatológica del carcinoma de mama en la provincia de Guantánamo. Método: Se realizó un estudio observacional, descriptivo, retrospectivo en 140 pacientes durante el período de 2010 a 2015 en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. El dato primario se obtuvo del Registro Provincial de Cáncer con diagnóstico de tumor maligno de mama. Resultados: La mayor incidencia de la enfermedad se registró a partir de los 45 años (80 %), el promedio de edad del diagnóstico fue de 57 más menos 15 años. La mama izquierda tuvo una mayor frecuencia a verse afectada con respecto a la mama la derecha (53 % vs. 46 %), fue poco frecuente que ambas mamas se encontrasen afectadas de forma sincrónica (menos del 1 %). El 53 % presentó una lesión de aspecto espiculado en la mamografía, de aspecto sólido en la ecografía y correspondiente a un carcinoma ductal infiltrante por histología. Conclusiones: Existe correlación entre los diagnósticos ecográficos, mamográficos y el diagnóstico definitivo histopatológico del cáncer de mama.
ABSTRACT Introduction: Since ancient times, breast cancer has been studied. It is current the most important invasive neoplasm in women and considered the leading cause of cancer deaths in women worldwide. Objective: To assess the ultrasound, mammographic and histopathological correlation for the diagnosis of breast cancer in Guantanamo province. Method: An observational, descriptive, and retrospective study was conducted in 140 patients during the period 2010-2015 at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo. The primary information was obtained from the Provincial Registry Database of Cancer with the diagnosis of malignant breast tumor. Results: The highest incidence of the disease was recorded in patients 45 plus years of age (80%), the average age at diagnosis was 57 ± 15 years. The left breast was more frequently affected than the right breast (53% vs. 46%), it was not common for both breasts be affected synchronously (less than 1%). The 53% of patients presented a lesion with a speculated appearance on mammography, solid appearance on ultrasound. This lesion, as per histology criteria, it corresponded to an infiltrating ductal carcinoma. Conclusions: There is a correlation between ultrasound, mammographic diagnoses and the breast cancer related definitive histopathological diagnosis.
RESUMO Introdução: O câncer de mama é conhecido desde a antiguidade, sendo o tumor de mama a neoplasia maligna mais importante na mulher. É considerada a principal causa de morte por câncer em mulheres no mundo. Objetivo: Avaliar a correlação ecográfica, mamográfica e histopatológica do carcinoma de mama na província de Guantánamo. Método: Estudo observacional, descritivo, retrospectivo, realizado em 140 pacientes durante o período de 2010 a 2015 no Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. Os dados primários foram obtidos do Registro Provincial de Câncer com diagnóstico de tumor maligno de mama. Resultados: A maior incidência da doença foi registrada após 45 anos (80%), a média de idade do diagnóstico foi de 57 anos mais ou menos 15 anos. A mama esquerda teve maior frequência de acometimento em relação à mama direita (53% vs. 46%), sendo raro que ambas as mamas fossem acometidas de forma síncrona (menos de 1%). 53% apresentavam lesão com aspecto espiculado na mamografia, aspecto sólido na ultrassonografia e correspondendo a carcinoma ductal infiltrante pela histologia. Conclusões: Existe correlação entre os diagnósticos ultrassonográfico e mamográfico e o diagnóstico histopatológico definitivo de câncer de mama.
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Breast squamous cell carcinoma are rare, occurring in less than 0.1% of all breast carcinomas. This report describes the oncological conduct performed on a patient with a triple negative squamous cell carcinoma in the upper outer quadrant of the right breast. The same patient presented a lobular carcinoma in situ within a fibroadenoma of the contralateral breast, during the follow up period. The association of these two diseases in the same patient has not yet been described in the literature.
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Breast cancer is one of the main sources of ovarian metastasis. Diffuse sheet of lobular carcinoma cells can strongly mimic granulosa cell tumor (GCT) which itself is a rare ovarian neoplasm constituting <5% of all the ovarian neoplasms. A 55-year-old female presented with a painful lump in the right breast associated with nipple discharge for 4 months, which on radiological and cytological findings was suspicious of an epithelial malignancy. During routine work-up, a solid-cystic lesion in the left ovarian adnexa was identified. The patient underwent right modified radical mastectomy along with left salpingo-oophorectomy. Histopathological and immunohistochemical features confirmed the diagnosis of a synchronous lobular carcinoma breast with GCT ovary. Simultaneous occurrence of Lobular carcinoma breast (LCB) and GCT ovary is extremely rare. Morphologically, these can look similar, raising a suspicion of LCB metastasis to ovary. This is important to differentiate the two for a proper patient management and prognosis
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ABSTRACT Introduction: Breast cancer is the second leading cause of cancer death among women worldwide, and epidemiological studies may help understanding its mechanisms. Objective: To carry out a survey of the number of breast cancer cases diagnosed in a period of six years. Methods: The profile of breast cancers diagnosed in a tertiary hospital in Curitiba was compared with the literature, using a retrospective analysis of ductal/special types and lobular breast carcinoma reports issued between 2008 and 2013. Results: Three hundred twenty-seven (91.6%) cases of ductal/special types carcinoma and 30 (8.4%) cases of lobular carcinoma were diagnosed, totaling 357 samples. From these cases, 27 (7.5%) were carcinoma in situ (20 ductal and seven lobular) and 330 (92.4%) were invasive carcinoma (307 invasive ductal/special types and 23 lobular). The prevalence of breast cancer among women was 991% and the majority of patients were older than 50 years of age (67.2%). Regarding the União Internacional de Controle do Câncer/American Joint Committee on Cancer (UICC/AJCC) staging, 49.2% of the ductal/special types tumors were diagnosed in Stages I or II, while 56.6% of lobular carcinomas were diagnosed in Stages II or III/IV. Regarding the Nottingham score, most cases were intermediate grade (43.9%). A total of 61% of the tumors were estrogen receptor positive (ER+) and 54% were progesterone receptor positive (PR+). Moreover, 36.1% presented positive human epidermal growth factor receptor 2 (HER2+), a rate higher than that indicated by the literature. Conclusion: The breast carcinomas evaluated in this study presented a profile similar to that reported in the literature, with some peculiarities inherent to the local pathology service. Nevertheless, the low frequency of in situ cases indicates failure in early diagnosis.
RESUMEN Introducción: El cáncer de mama es la segunda causa de muerte por cáncer entre mujeres alrededor del mundo, y estudios epidemiológicospueden contribuir al entendimiento de sus mecanismos. Objetivos: Determinar el número de casos de carcinoma de mama diagnosticados en un período de seis anos. Método: El perfil de los carcinomas de mama diagnosticados en un hospital terciario de Curitiba ha sido comparado con aquel de la literatura, a través de análisis retrospectivo de historias de carcinoma de mama ductal/tipos especialesy lobulillar de pacientes atendidos entre los anos de 2008y 2013. Resultados: Se han diagnosticado 327 (91,6%) casos de carcinoma ductal/tipos especiales y 30 (8,4%) de carcinoma lobulillar, totalizando 357 muestras. De estos casos, 27 (7,5%) eran de carcinoma in situ (20 ductaly siete lobulillar) y 330 (92,4%), invasores (307 ductal invasor +tipos especialesy 23 lobulillar). La incidencia de tumores de mama en mujeres fue de 99,1%, siendo los pacientes, en su generalidad, mayores de50 anos (67,2%). Con respecto a la estadificación de Unión Internacional Contra el Cáncer/American Joint Committee on Cancer (UICC/AJCC), 49,2% de los tumores ductales + tipos especiales fueron diagnosticados en los estadios I o II, mientras 56,6% de los tumores lobulillares se concentraron en los estadios II o III/IV. En cuanto al sistema de Nottingham, gran parte de los casos era de grado intermediario (43,9%). Un total de 61% de los tumores era receptor de estrógeno positivo (RE+) y 54%, receptor de progesterona positivo (RP+). Por otro lado, 36,1% presentaron el receptor 2 del factor de crecimiento epidérmico humano positivo (HER2+), tasa superior a la indicada en la literatura. Conclusión: Los carcinomas de mama evaluados en este estudio presentaron perfil semejante al expuesto en la literatura, con algunaspeculiaridades inherentes al servicio local. Sin embargo, la baja frecuencia de casos in situ indica fracaso en el diagnóstico precoz.
RESUMO Introdução: O câncer da mama éa segunda causa de morte por câncer entre as mulheres em todo o mundo, e estuáis epidemiológicos podem auxiliar no entendimento dos seus mecanismos. Objetivos: Realizar um levantamento do número de casos dos carcinomas da mama diagnosticados em um período de seis anos. Método: Foi comparado com a literatura o perfil dos carcinomas da mama diagnosticados em um hospital terciário de Curitiba, por meio da análise retrospectiva dos laudos de carcinomas da mama ductal/ tipos especiais e lobular de pacientes atendidos entre os anos de 2008 e 2013. Resultados: Foram diagnosticados 327 (91,6%) casos de carcinoma ductal/tipos especiais e30 (8,4%) de carcinoma lobular, totalizando 357 amostras. Desses casos, 27 (7,5%) eram de carcinoma in situ (20 ductal esete lobular) e330 (92,4%), invasores (307ductal invasor + tipos especiais e 23 lobular). Aprevalência de tumores da mama nas mulheres foi de 99,1%, tendo os pacientes, na sua maioria, mais de 50 anos (67,2%). Em relação ao estadiamento da União Internacional de Controle do Câncer/American Joint Committee on Cancer (UICC/AJCC), 49,2% dos tumores ductal + tipos especiais foram diagnosticados em estadio Iou II, enquanto 56,6% dos tumores lobular concentraram-se nos estadios II ou III/IV Quanto à escala de Nottingham, grande parte dos casos era de grau intermediário (43,9%). Um total de 61% dos tumores eram receptor de estrogênio positivo (RE+) e 54%, receptor de progesterona positivo (RP+). Por outro lado, 36,1% apresentaram receptor 2 de fator de crescimento epidermal humano positivo (HER2+), taxa superior à indicada pela literatura. Conclusão: Os carcinomas da mama avaliados neste estudo apresentaram perfil semelhante ao exposto na literatura, com algumas peculiaridades inerentes ao serviço local. Entretanto, a baixa frequência de casos in situ indica falha no diagnóstico precoce.
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PURPOSE: We investigated the prognostic significance of CD9 expression in tumor cells of patients with invasive lobular carcinoma (ILC). METHODS: CD9 expression was evaluated by immunohistochemistry in 113 ILC tissue samples. Correlation of CD9 expression with the patients' clinicopathological parameters and overall survival was assessed. RESULTS: CD9 expression was detected in 48 (42.5%) ILC patients. However, no significant relation could be determined between CD9 expression and the clinicopathological parameters of the patient including tumor size, lymph node metastasis, lymphovascular invasion, histologic grade, expression of hormone receptors, human epidermal growth factor receptor 2 status, and Ki-67 labeling index. Patients with CD9 expression had worse overall survival (p = 0.051) and disease-free survival (DFS, p = 0.014) compared to patients without CD9 expression. Multivariate analysis revealed that CD9 expression was an independent prognostic factor for DFS (p = 0.049). CONCLUSION: CD9 expression in tumor cells could be a significant prognostic marker in patients with ILC.
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Humans , Breast Neoplasms , Carcinoma, Lobular , Disease-Free Survival , Immunohistochemistry , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Prognosis , ErbB ReceptorsABSTRACT
Objective: The aim of this study is to depict the clinical and epidemiological profile of patients treated for invasive lobular carcinoma (ILC) at Hospital das Clínicas of Universidade Federal do Paraná (HC-UFPR) over the course of ten years and to evaluate the variation of ILC dimensions on imaging exams by comparing them to real-size lesions identified in surgical specimens. Methods: Patients undergoing breast surgical procedures at HC-UFPR from 2005 to 2014 were selected. Out of these, 36 were diagnosed with ILC and had their medical files sought after clinical, epidemiological, therapeutic and prognosis characteristics. The variance of tumor sizes in imaging methods and anatomopathological descriptions were also studied. Results: Patients' mean age at diagnosis was 59.6 years. Most of them were classified as clinical stages II (40%) and III (26.7%) by the time they were diagnosed. The majority of tumors were HER2 negative (77.2%) and estrogen-receptor positive (90%). The surgical treatment was radical in 74.2% of the cases. 31.4% of the patients underwent both mammography and ultrasonography screening and 45.7% underwent only one of them. None of the patients were submitted to magnetic resonance imaging (MRI). Conclusion: Data found about patients with invasive lobular carcinoma at HC-UFPR is in accordance with the medical literature, including incidence rates and tumor characteristics. The variance of tumor sizes in imaging exams and surgical specimen was not statistically significant
Objetivo: O estudo busca caracterizar o perfil clínico epidemiológico referente às pacientes tratadas por carcinoma lobular invasor de mama (CLI) no Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) em um período de dez anos e avaliar as variações das dimensões dos CLI nos exames de imagem quando comparadas ao real tamanho das lesões identificadas nas peças de anatomia patológica. Métodos: Foram selecionadas pacientes submetidas a procedimentos cirúrgicos de mama no HC-UFPR entre os anos de 2005 e 2014, dentre as quais 36 apresentaram diagnóstico de CLI. Seus prontuários foram analisados para avaliação de características clínicas, epidemiológicas, terapêuticas e prognósticas. Também foi avaliada a discrepância dos valores de tamanho do tumor em métodos de imagem em relação ao descrito nos laudos anatomopatológicos. Resultados: A s p acientes c om d iagnóstico d e C LI tinham média de idade no diagnóstico de 59,6 anos. O diagnóstico foi feito, em sua maioria, nos estádios clínicos II (40%) e III (26,7%). Houve maior negatividade (77,2%) para HER2 e positividade (90%) para receptor de estrógeno. O tratamento cirúrgico foi radical em 74,2% das pacientes. Em exames de imagem, 31,4% das pacientes realizaram mamografia e ultrassonografia em conjunto, 45,7% fizeram apenas um dos exames e nenhuma realizou ressonância magnética. Conclusão: Observou-se que a casuística de patologias mamárias do HC-UFPR está de acordo com a literatura em relação à incidência e às características próprias dos CLI. A análise da discrepância dos tamanhos dos tumores em exames de imagem em relação às peças cirúrgicas não obteve resultados significativos estatisticamente
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Metastasis from primary cancer to the thyroid is uncommon in breast cancer. Here we present a case of lobular breast carcinoma that metastasized to the thyroid. A 54-year-old woman without symptoms was admitted to our institution for staging of the lymph node above the left clavicle. An ¹⁸F-fluoro-deoxy-D-glucose positron emission tomography scan was performed for staging, and low uptakes were observed in the left supraclavicular and cervical lymph nodes. High uptake was seen in the posterior and lower left lobe of the thyroid. Histologic findings indicated lobular breast carcinoma (positive GATA3, loss of E-cadherin expression) metastatic to the thyroid with a luminal profile. Immunohistochemical analysis was negative for primary thyroid or parathyroid carcinoma. To our knowledge, this is the first report of a patient presenting a metastatic invasive lobular carcinoma in the thyroid and lymph nodes without a prior diagnosis of breast cancer.
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Female , Humans , Middle Aged , Breast Neoplasms , Breast , Cadherins , Carcinoma, Lobular , Clavicle , Diagnosis , Immunohistochemistry , Lymph Nodes , Neoplasm Metastasis , Parathyroid Neoplasms , Phenobarbital , Positron-Emission Tomography , Thyroid GlandABSTRACT
Resumen ANTECEDENTES: La afectación mamaria por un linfoma es poco frecuente; casi siempre se trata de linfomas tipo B que se caracterizan por falta de especificidad clínica y radiológica, lo que dificulta el diagnóstico diferencial con tumoraciones mamarias de otro origen. CASO CLÍNICO: Paciente de 72 años de edad, con antecedentes de hipercolesterolemia, hipertensión arterial, artrosis y depresión, con dos partos y menopausia a los 55 años. Madre con antecedente de cáncer de mama posmenopáusico. En la mamografía de la mama derecha se encontró una masa retroareolar de 8 cm, de contornos mal definidos y una adenopatía axilar con engrosamiento cortical. La biopsia reportó un linfoma no Hodgkin B de alto grado. Se administraron 8 ciclos de quimioterapia con el esquema R-CHOP. Luego de este esquema el PET-TC mostró una lesión mamaria derecha residual, metabólicamente inactiva, sin enfermedad nodal ni extramamaria supra ni infradiafragmática. CONCLUSIONES: Una neoplasia maligna mamaria no siempre se trata de un carcinoma ductal o lobulillar. Es necesario valorar la posibilidad de otras estirpes histológicas o, incluso, de una afectación metastásica. La entrevista y exploración adecuadas son fundamentales para una buena orientación diagnóstica.
Abstract BACKGROUND: The mammary affectation by a lymphoma is not frequent; it almost always involves type B lymphomas. It is characterized by a lack of clinical and radiological specificity, which makes differential diagnosis difficult with mammary tumors of another origin. CLINICAL CASE: A 72-year-old patient with a history of hypercholesterolemia, hypertension, osteoarthritis and depression, with two deliveries and menopause at 55 years of age. Mother with a history of postmenopausal breast cancer. The mammography of the right breast reported the existence of a retroareolar mass of 8 cm, of ill-defined contours and an axillary adenopathy with cortical thickening. The biopsy reported a high-grade non-Hodgkin B lymphoma. 8 cycles of chemotherapy were administered with the R-CHOP scheme. After this procedure, the PET-CT showed a residual, metabolically inactive right mammary lesion, with nodal or extramammary supra or infradiaphragmatic disease. CONCLUSIONS: A malignant mammary neoplasm is not always a ductal or lobular carcinoma. It is necessary to evaluate the possibility of other histological strains or, even, of a metastatic affectation. The adequate interview and exploration are fundamental for a good diagnostic orientation.
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OBJECTIVES: We aimed to compare the diagnostic performances of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), magnetic resonance imaging (MRI), breast specific gamma imaging (BSGI) and/or positron emission tomography/computed tomography (PET/CT) for the detection of invasive lobular carcinoma (ILC). METHODS: Index ILCs and multifocal/multicentric (multiple) ILCs were analyzed using various imaging modalities. The final surgical pathology was regarded as the reference standard. The detection rate for index cancers and the diagnostic performance for multiple ILCs per breast were evaluated. RESULTS: Seventy-eight ILCs in 76 women were enrolled. Twenty-six breasts had multiple ILCs. DM (n=72), DBT (n=15), US (n=77), MRI (n=76), BSGI (n=50), and /or PET/CT (n=74) were performed. For index cancer, the detection rate was 100% for DBT, US, and MRI. For multiple ILCs, the sensitivity was 100% for DBT and MRI (P<0.001). The diagnostic accuracy for multiple ILCs were 73.3% for DBT and 73.0% for PET/CT (P=0.460). CONCLUSION: DBT was the most accurate imaging modality for both index and multiple ILCs. PET/CT was also valuable for multiple ILCs, whereas DM and BSGI showed relatively low diagnostic performances. DBT and PET/CT have promising roles in the diagnosis of multiple ILCs.
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Female , Humans , Breast , Carcinoma, Lobular , Diagnosis , Electrons , Magnetic Resonance Imaging , Mammography , Pathology, Surgical , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , UltrasonographyABSTRACT
Objective To study the meaning of breast cancer staging system by AJCC eighth edition to invasive lobular carcinoma and analysis the clinical pathological characteristics.Methods According to the eighth edition of the AJCC staging to evaluate the TNM stage and prognosis evaluation of invasive lobular carcinoma cancer patient in Peking University Shenzhen Hospital from 2011 to 2016,and compared with others in clinical pathological data.Results There were 21 cases of invasive lobular carcinoma,accounting for 2.7％ of all invasive breast cancer.We found that invasive lobular carcinoma shows no significant difference (P ＞ 0.05) in ages,menstrual status,molecular features and anatomic staging and prognosis staging with others;histological grade were significantly different (P ＜ 0.05).There were significant differences in the prognosis and staging of invasive lobular carcinoma.Conclusions Eighth AJCC staging systemn provides a new reference for the clinical treatment of breast cancer,should be evaluated with anatomic stage.Histological grade is relatively good in invasive lobular carcinoma and the prognosis is good,needs more research to the individualized treatment of invasive lobular carcinoma.
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Objective: To analyze and compare the clinicopathological features and prognostic factors between patients with advanced breast invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Methods: Fifty-nine female patients with advanced breast ILC from Tianjin Medical University Cancer Institute and Hospital were included in this retrospective case-controlled study. Matched two hundred and thirty-six female patients with advanced breast IDC were selected according to age at diagnosis and the time of surgery (±2 years) in Tianjin Medical University Cancer Institute and Hospital between January 2008 and December 2016. Clinical and pathological features and prognostic factors were analyzed by using univariate and multivariate analyses. Results: The clinical pathological features of clinical stage at initial diagnosis, T stage, M stage, histological degree, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor-2 (HER-2) status and molecular subtype were significantly different between two groups (all P < 0.05). The median ages at recurrence/metastasis of patients with breast ILC and IDC were 50 years (range: 28-73) and 51 years (range: 27-69), respectively. The differences in the number of first metastatic sites, lymph node metastasis, visceral metastasis, lung metastasis and bone metastasis were statistically significant between two groups (all P < 0.05). The median progression-free survivals of patients with breast ILC and IDC were 14 months (range: 2-62) and 11 months (range: 1-89), respectively (P = 0.121). The median metastasesoverall survivals (M-OS) of patients with ILC and IDC were 42 months (range: 5-78) and 44 months ((range: 1-110), respectively (P = 0.392). Multivariate analysis revealed that PR status, age at recurrence or metastasis and treatment of bone metastases were the independent predictors of survival in patients with advanced breast ILC (all P < 0.05). The molecular subtype, the number of first metastatic sites and pleural effusion were the independent prognostic factors in patients with breast IDC (all P < 0.05). Conclusion: Patients with advanced breast ILC have unique clinicopathological, recurrent/metastatic and prognostic features. It is necessary to reveal the definitive features of ILC and develop new personalized precision therapies.
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Invasive lobular carcinoma (ILC) is the second most common kind of breast cancer. Diffusion weighted imaging (DWI) and positron emission tomography/computed tomography (PET/CT) are functional modalities for presenting the biological characteristics of breast cancer. The purpose of this article is to study the relationship between DWI or PET/CT and ILC's prognostic factors. The relationship between the apparent diffusion coefficient (ADC) values, standard uptake value (SUV)max and prognostic factors of ILC were statistically evaluated. The ADC values were lower in mass types of ILC. SUVmax was statistically higher in grade 3 and 4 background parenchymal enhancement and positive lymph node metastasis. ADC values of DWI and SUVmax of PET/CT can be helpful in the prediction of the prognosis of ILC.
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Breast , Breast Neoplasms , Carcinoma, Lobular , Diffusion , Diffusion Magnetic Resonance Imaging , Electrons , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , Population Characteristics , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , PrognosisABSTRACT
Invasive lobular carcinoma (ILC) is the second most common kind of breast cancer. Diffusion weighted imaging (DWI) and positron emission tomography/computed tomography (PET/CT) are functional modalities for presenting the biological characteristics of breast cancer. The purpose of this article is to study the relationship between DWI or PET/CT and ILC's prognostic factors. The relationship between the apparent diffusion coefficient (ADC) values, standard uptake value (SUV)max and prognostic factors of ILC were statistically evaluated. The ADC values were lower in mass types of ILC. SUVmax was statistically higher in grade 3 and 4 background parenchymal enhancement and positive lymph node metastasis. ADC values of DWI and SUVmax of PET/CT can be helpful in the prediction of the prognosis of ILC.
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Breast , Breast Neoplasms , Carcinoma, Lobular , Diffusion , Diffusion Magnetic Resonance Imaging , Electrons , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , Population Characteristics , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , PrognosisABSTRACT
Objective: To investigate the clinical features and the relationship between molecular subtypes and the clinical features and prognosis of invasive lobular carcinoma (ILC) of breast. Methods: The clinical records of 381 patients with resectable breast ILC in Tianjin Medical University Cancer Institute and Hospital were collected from January 1, 2003 to December 31, 2012. Based on the result of immunohistochemistry, four molecular subtypes were determined, including Luminal A, Luminal B, human epidermal growth factor receptor 2 (HER2) over-expression and triple-negative breast cancer (TNBC). The correlations of the prognosis in patients with different breast cancer molecular subtypes and the clinicopathological characteristics were analyzed. Results: The proportions of the four molecular subtypes were different; Luminal B accounted for the highest proportion (66.4%) and the proportions of Luminal A, HER2 over-expression and TNBC were 16.8%, 5.5% and 11.3%, respectively. There were statistical differences among different molecular subtypes of breast ILC regarding the age, menopausal status and lymph node metastasis (all P<0.05). The univariate analysis showed that factors affecting the prognosis of breast ILC were tumor size, axillary lymph node metastasis, clinical stage, molecular subtypes, surgical method, post-operative radiotherapy and endocrine therapy (all P<0.05). The 5-year overall survival rates of patients with Luminal A and Luminal B subtypes were 100.0% and 91.2%, respectively, which were significantly higher than those of the HER2 over-expression and TNBC subtypes (55.6% and 50.9%, respectively). Multivariate analysis found that the tumor size, molecular subtypes, axillary lymph node metastasis and endocrine therapy were the independent prognostic factors of breast ILC (all P<0.05). Conclusion: Molecular subtype classification has great significance in predicting the prognosis of breast ILC. Further studies are needed to guide the individual treatment of breast ILC.
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PURPOSE: The purpose of this study was to identify the clinical and pathological factors that differentiate pleomorphic invasive lobular carcinoma (PILC) from classic invasive lobular carcinoma (CILC). METHODS: We retrospectively reviewed the medical records of 65 patients (4.0% of all invasive breast cancer patients) who underwent surgical excision for invasive lobular carcinoma (ILC) between January 2000 and November 2013. All 65 patients were diagnosed with ILC with negative immunohistochemical staining for E-cadherin in the tumor cells. All hematoxylin and eosin slides of the previously diagnosed ILC were reviewed and confirmed by two expert pathologists and we compared the clinicopathologic features between CILC and PILC. RESULTS: CILC was found in 46 cases and PILC, in 19 cases. Of the mammographic findings, a mass or asymmetric density was the most common feature (42.3% of all ILC patients). The most common ultrasonographic feature was a mass (94.9% of all ILC patients). Tumor multiplicity was noted in 10 patients (15.4%) among all ILC patients; eight patients (17.4%) had CILC and two patients (10.5%) had PILC. PILC patients had more grade III tumors (66.7% vs. 8.7%, p=0.002) and a higher Ki-67 labeling index (55.6% vs. 18.6%, p=0.004) than those with CILC. There were no statistical differences in the type of combined in situ component, extensive intraductal component, tumor size, lymphovascular invasion, stage, hormone receptor status, human epidermal growth factor receptor 2 status, distribution of intrinsic subtype, or imaging findings. Moreover, there was no significant difference in survival between CILC and PILC. CONCLUSION: PILC showed more pathological aggressiveness than CILC in terms of tumor grade and Ki-67 index.
Subject(s)
Humans , Breast , Breast Neoplasms , Cadherins , Carcinoma, Lobular , Eosine Yellowish-(YS) , Hematoxylin , Medical Records , ErbB Receptors , Retrospective StudiesABSTRACT
Background : With growing awareness in the general population, especially about breast pathologies, a lady with a breast lump is one of the commonest presentations in outpatient departments. Clinical examination would be followed in most patients with a confirmatory diagnosis under the microscope. Aim : The aim of the study is to evaluate the clinico-morphological patterns of palpable breast lump in Tripura. Methods: This retrospective study was conducted from January 2010 to January 2015 in Tripura Medical College and Dr BRAM Teaching Hospital. Study included all diagnosed cases of female breast lump during the above mentioned period. Detailed clinical data including age, site, side, family history and histological reports were retrieved from the records section. Observation: A total number of 140 cases studied ranging from 18 years to 80 years having a mean age of 49 years. Most common age group was seen in 18-30 years for benign lesions and 40- 60 years for malignant lesions. The commonest type of benign lesion was Fibroadenoma with 58 cases (76.3%) and in malignant lesions Infiltrating duct carcinoma was the commonest type with 32 cases (50%), followed by medullary carcinoma with 16 cases (25%). The disease was found on the left side in 91 cases (65%) and on the right side in 48 cases (34.3%) and bilateral in 1 case (0.71%). In cases of malignancy TNM Staging was available in 32 cases. Majority of the cases were stage II,
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Purpose To investigate the clinicopathological characteristics and the survival outcomes of invasive lobular carcinoma. Methods A retrospective analysis of 98 patients with invasive lobular carcinoma and 530 invasive carcinoma of no special type was performed in order to observe the histological features and the clinical outcomes of invasive lobular carcinoma. Results Median follow-up was 68. 5 months for invasive lobular carcinoma and 67 months for invasive carcinoma of no special type. Invasive lobular carcinoma presented with a larger tumor size, more histopathological grade 2 tumors, increased rate of hormonal receptor positivity, human epider-mal growth factor 2 (HER-2) negativity, and had a lower proliferative index as compared to invasive carcinoma of no special type, more frequently presented with the luminal A subtype (P<0. 001). The classical invasive lobular carcinoma presented with a smaller tumor size, to have a lower histological grade and proliferative index compared to the non-classic type, and more frequently presented with the luminal A subtype, whereas the non-classic invasive lobular carcinoma patients more frequently presented with the luminal B, HER-2 overexpression, or triple negative subtype (P=0. 035). A statistically significant difference in the outcome was observed at un-ivariate analysis for patients with non-classic for disease-free survival (P=0. 043) and for overall survival (P=0. 048), as compared with patients with classical invasive lobular carcinoma. The disease-free survival difference between the invasive lobular carcinoma and the invasive carcinoma of no special type was not significant (P=0. 537), and the overall survival rates were not statistically different between the two groups (P=0. 397). A statistically significant difference of overall survival was observed at multivariate analysis for patients with HER-2 positive and triple negative subtypes versus patients with luminal A invasive lobular carcinoma (P=0. 015, P=0. 016) . Conclusions The outcome of invasive lobular carcinoma is significantly correlated with histological and immunohistochemi-cally defined molecular subtypes. New tailored strategies should be explored in these subgroups of patients with poor outcome.
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Purpose To investigate the expression of EZH2 and p53 protein in breast cancer and to analyze their relationship with the clinical pathologic characteristics and prognosis. Methods The expression of EZH2 and p53 protein were detected by immunohisto-chemical method in 50 cases of breast adenosis tissues, 92 cases of breast invasive lobular carcinoma ( ILC) and 200 cases of breast in-vasive ductal carcinoma ( IDC) , and their correlation was also analyzed. Results There was no statistical significance of EZH2 be-tween ILC and IDC (P>0. 016 7), while its expression in breast adenosis tissues was lower than that in ILC and IDC (P0. 016 7), while its expression in IDC was higher than that in ILC and breast adenosis tissues (P<0. 016 7). Its expression had no related to patient age, menopausal status, tumor size, lymph node metastasis in breast cancer, but related to histological types, pTNM stage, molecular subtype and sur-vival status (P<0. 05). The Kaplan-Meier survival analysis showed the expression of EZH2 and p53 had correlated with disease-free and overall survival rates of breast cancer (P<0. 05). Multivariate COX regression analysis showed that the expression of EZH2 and p53 were independent affecting factors to breast cancer patients. Conclusion The expression of EZH2 and p53 protein increase in the breast adenosis, ILC and IDC gradually, and they have positive correlation. The expression levels of EZH2 and p53 protein have im-portant value to evaluate the prognosis of breast cancer patients.
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Purpose To investigate the clinical and morphological features as well as immunophenotype of pleomorphic lobular carcino-ma ( PLC) . Methods Seven cases of PLC were retrieved from 34 cases of invasive lobular carcinoma. The clinical data, histologic features, immunohistochemical findings were analyzed. Results The mean age of the patients was 56. 6 years, with a range of 47 to 74 years. PLC might be nodular mass in general macroscopy. Histologically, PLC retained classical or non-classical single cells, but exhibited a greater degree of cellular atypia and pleomorphism and a higher mitotic rate than classic invasive lobular carcinoma ( ILC) . PLC was accompanied by ductal carcinoma in situ ( DCIS) and pleomorphic lobular carcinoma in situ ( PLCIS) . Immunohistochemistry and HER-2 FISH were detected. PLC showed E-cadherin negative (7/7) and p120 cytoplasmic positive (7/7), ER (5/7), PR (5/7), and HER-2 (7/7) mostly negative. 5 cases were characterized by triple negative breast cancer, two of which are basal-like pheno-type. Some cases could be observed nerve invasion (3/7) and axillary lymph node metastasis (4/7). Conclusion PLC is a very rare subtype of invasive lobular carcinoma. In some cases there are nerve invasion and lymph node metastasis. The diagnosis of PLC de-pends on the pathological morphological and immunohistochemical markers.
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PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.