Medullary carcinoma of jejunum presenting as perforation peritonitis: A case report

Small intestinal medullary carcinoma (MC) is a newly recognized subclass of small intestinal carcinomas and is an exceptional entity for this site. A search of the literature for similar cases arising in the small intestine revealed only six previously reported cases. Here we present a case of MC arising in the jejunum of a 65-year-old male. The patient presented to the emergency with features of perforation peritonitis with liver metastasis and no known predisposing factors like inflammatory bowel disease and celiac disease. Studies conducted on this tumor's colonic counterpart have shown microsatellite instability (MSI) and B-type Raf kinase (BRAF) mutations; however, few exceptions are known. Also, this subtype of carcinoma is known to have a better prognosis than its other histological subtypes.

Carcinoma of breast with medullary features: a case report in 27 year old female

Medullary carcinoma of breast is a rare variant of invasive ductal carcinoma of breast and its incidence is less than 5% of invasive breast carcinomas. These tumours tend to occur in younger women, with the average age reported to range from 42 to 52 years. Authors are presenting this case in a 27 years old female having single, large, well circumscribed mass in right breast for 6 months. Fine needle aspiration cytology report was proliferative lesion with atypia Histopathology report was given as carcinoma with medullary features. Immunohistochemistry showed Estrogen Receptor (ER), Progesterone Receptor (PR) and Her-2 neu negative. Authors are presenting this case of Medullary carcinoma of breast for being a specific histopathological subtype.

Concurrent Medullary Thyroid Carcinoma and Primary Thyroid Lymphoma (Diffuse Large B Cell Lymphoma): the First Case Report

Cases of simultaneously occurring medullary thyroid carcinoma (MTC) and lymphoma are extremely rare. An 84-year-old woman visited the hospital due to dyspnea, resulting from rapidly aggravated enlarged neck mass. Ultrasonography revealed two lesions in the thyroid and they were diagnosed as concurrent medullary thyroid carcinoma and diffuse large B cell lymphoma after total thyroidectomy. A few cases simultaneously diagnosed with MTC and systemic lymphoma have been reported. However, the coexistence of MTC and primary thyroid lymphoma is extremely rare.

Ultrasound diagnosis of type 2 multiple endocrine neoplasm: A report of 2 cases / 第二军医大学学报

ObjectiveTo explore the pathogeneic characteristics and ideas of ultrasonic diagnosis of type 2 multiple endocrine neoplasm (MEN-2) , so as to improve the clinical diagnosis rate. Methods The clinical data of 2 patients with pathologically confirmed MEN-2 in Changzheng Hospital of Naval Medical University (Second Military Medical University) were retrospectively analyzed. The pathogenic characteristics of 2 patients were summarized. The process of ultrasound diagnosis was discussed, and the ideas of ultrasound diagnosis was summarized. ResultsPatient 1 presented with hypertension. Abdominal ultrasonography showed multiple pheochromocytomas in the bilateral adrenal glands, which attracted attention because of bilateral involvement. Further examination of other endocrine glands revealed that the right upper and middle thyroid junction had an occupation, and there was no abnormality in the pancreas. Ultrasound finally diagnosed medullary thyroid carcinoma. Patient 2 had recurrent urinary calculi for many years. Considering its symptoms might be caused by hyperparathyroidism, we performed ultrasonography and found hyperplasia of parathyroid gland and medullary thyroid cancer. Therefore, we further examined several endocrine organs such as pancreas and adrenal gland, and finally found pheochromocytoma of adrenal gland. Based on the different clinical symptoms of the 2 patients, we made accurate diagnoses through ultrasound examination of endocrine glands associated with multiple lesions combined with pathological results. ConclusionMEN-2 has a variety of clinical manifestations and is difficult to diagnose. It is helpful for early diagnosis of MEN-2, a multi-organ involvement disease, by mastering its pathogenic characteristics, clinical characteristics and ultrasound diagnosis ideas.

Invasive lobular carcinomas treated at Hospital de Clínicas of UFPR: incidence, characteristics and clinical outcome / Carcinomas lobulares invasores de mama tratados no Hospital de Clínicas da UFPR: incidência, características e evolução clínica

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

Oncocytic variant of medullary thyroid carcinoma: 3 cases report with review of literatures / 临床与实验病理学杂志

Purpose To investigate the clinicopathologic features and differential diagnosis of oncocytic variant of medullary thyroid carcinoma (MTC).Methods Morphological,immunohistochemical findings on 3 oncocytic variant of MTC cases and electron microscopic findings on 2 of these 3 cases were studied,with review of the relevant literatures.Results The cytoplasm was abundant,eosinophilic and granular with defined margins.The nuclei were enlarged,round to oval.Prominent nucleoli were identified in some cells.Tumor cells formed sheets,trabeculae or follicles with infiltrative pattern.Immunohistochemically,thyroglobulin (TG) was negative in all 3 cases.Calcitonin was positive in 2 cases and negative in 1 case.Ultrastructurally,a large number of mitochondria and various neuroendocrine granules were found in the 2nd and 3rd cases.Conclusion Oncocytic variant of MTC is very rare with variable histopathologic appearances.It should be considered in diagnosing oncocytic lesions of thyroid.A definite diagnosis can be rendered based on comprehensive findings of the immunohistochemistry,serology study and electron microscopy.It needs to avoid misdiagnosis and missed diagnosis.

Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma / Utilidade da calcitonina sérica pré-operatória em pacientes com doença nodular tireoidiana sem história ou citologia suspeitas para carcinoma medular de tireoide

OBJECTIVE: To evaluate the usefulness of preoperative serum calcitonin (sCT) in patients with nodular disease without suspicion of medullary thyroid carcinoma (MTC) in history or cytology. PATIENTS AND METHODS: sCT was measured before thyroidectomy in 494 patients with nodular disease who had no family history of MTC or multiple endocrine neoplasia type 2, and no cytological suspicion of MTC. RESULTS: Basal sCT was < 10 ng/mL in 482 patients and none of them had MTC. One patient with basal sCT > 100 pg/mL had MTC. Among the 11 patients with basal sCT between 10 and 100 pg/mL, MTC was diagnosed in only one. The two patients with MTC were submitted to total thyroidectomy, combined with elective lymph node dissection indicated exclusively based on hypercalcitoninemia, and sCT was undetectable after six months. CONCLUSIONS: Preoperative sCT is useful for the detection of sporadic MTC in patients with nodular disease, even in the absence of suspicious history or cytology.

OBJETIVO: Avaliar a utilidade da calcitonina sérica (sCT) pré-operatória em pacientes com doença nodular sem suspeita de carcinoma medular de tireoide (CMT) pela história e citologia. PACIENTES E MÉTODOS: Antes da tireoidectomia, sCT foi dosada em 494 pacientes com doença nodular, sem história familiar de CMT ou neoplasia endócrina múltipla tipo 2 e sem citologia suspeita para CMT. RESULTADOS: sCT basal foi < 10 ng/ml em 482 pacientes e nenhum possuía CMT. Um paciente com sCT basal > 100 pg/ml realmente possuía CMT. Dos 11 pacientes com sCT basal entre 10 e 100 pg/ml, CMT foi diagnosticado em apenas um. Os dois pacientes com CMT foram submetidos à tireoidectomia total com dissecção eletiva de linfonodos, indicada exclusivamente pela hipercalcitoninemia, e após seis meses apresentaram sCT indetectável. CONCLUSÕES: Em pacientes com doença nodular, mesmo sem história ou citologia suspeitas, a sCT pré-operatória é útil para detecção do CMT esporádico.

Clinicopathologic characteristics and treatment of medullary thyroid carcinoma / 中华内分泌外科杂志

Objective To explore the clinicopathologic characteristics and treatment of medullary thyroid carcinoma(MTC).Methods The data of 42 cases of MTC admitted to Fujian Medical University Provincial Clinical College from Jan 1995 to Feb 2010 were retrospectively analyzed.Surgery was performed in all the 42 cases.All were proved to be MTC by pathology.Results Surgery was performed in all the 42 cases.All were proved to be MTC by pathology.The lymph node metastasis rate was 76.19％ (32/42).The central lymph node metastasis rate was 61.90％ (26/42).All the 42 cases were followed up for 1 to 502 months with 102 months as the median.35 cases(83.33％)were followed up for more than 5 years and the 5-year overall survival rate was 85.71％ (30/35).Death occurred in 5 cases.Conclusions The lymph node metastasis rate of MTC is high.The treatment should be based on the principle of radical resection.Total thyroidectomy should be recommended to treat primary tumor.Lymph node dissection should be as thorough as possible.Central compartment neck dissection should be done in all cases.

A Case of Concurrent Papillary and Medullary Thyroid Carcinomas Detected as Recurrent Medullary Carcinoma after Initial Surgery for Papillary Carcinoma / 대한갑상선학회지

As the prevalence of thyroid carcinoma is rapidly increasing, coexisting subtypes of thyroid carcinomas are often found. However, concurrent papillary and medullary carcinomas in the thyroid gland are extremely rare. We report the case of a 50-year-old man with co-occurrence of multiple papillary and medullary thyroid carcinomas; the latter were undetected at initial diagnosis. Sixty-three months after the initial operation performed because of papillary carcinoma diagnosis, a metastatic lymph node was detected in the left level IV region, which was revealed as medullary carcinoma. The histopathologic results from initial surgery were reviewed, and we found multiple coexisting medullary carcinomas that were not identified initially. The incidence of concurrent papillary and medullary thyroid carcinomas will continue to increase as rates of diagnosis of and surgery for thyroid carcinoma increase. Therefore, surgeons and pathologists should be aware of the possible coexistence of subtypes of thyroid carcinomas to avoid missing concurrent lesions.

Comparison of the Characteristics of Medullary Breast Carcinoma and Invasive Ductal Carcinoma / 한국유방암학회지

PURPOSE: Medullary breast carcinomas (MBC) have been known to represent a rare breast cancer subtype associated with a more favorable prognosis than invasive ductal carcinomas (IDC). The purpose of this study was to compare the clinicopathologic characteristics and outcomes of MBC with those of IDC. METHODS: We retrospectively reviewed medical records of patients with invasive breast cancer who were managed surgically from August 1995 to June 2010. RESULTS: Fifty-two patients were identified with MBC and 5,716 patients were identified with IDC. The clinicopathologic features, disease-free survival (DFS), and overall survival (OS) of patients with MBC were compared with those of patients with IDC. The MBC group presented at a younger age (p=0.005) and had a significant association with a higher histological grade (p=0.003) and nuclear grade (p<0.001) as well as negative estrogen receptor (p<0.001) and progesterone receptor (p<0.001) status. Lymphatic invasion was absent (p<0.001) and lymph node metastasis was rare (p<0.001). The DFS and OS did not differ significantly between the two groups (5-year DFS: 88.0% vs. 89.2%, p=0.920; 5-year OS: 93.4% vs. 94.4%, p=0.503). In multivariate analysis, the factors associated with DFS and OS were nuclear grade, histological grade, tumor size, lymph node metastasis, estrogen receptor status, progesterone receptor status, and human epidermal growth factor receptor 2 status, chemotherapy, and hormone therapy. However, DFS and OS were not significantly different between IDC and MBC according to histological type itself (DFS: hazard ratio 0.85, 95% confidence interval 0.12-6.05, p=0.866; OS: hazard ratio 1.49, 95% confidence interval 0.21-10.77, p=0.692). CONCLUSION: Although MBC has specific clinicopathologic features, its prognosis does not differ from IDC and is determined by prognostic factors such as tumor size and lymph node metastasis. Therefore, patients with MBC also require the same intensive treatment provided for IDC.

Granular Cell Tumor of Thyroid Gland That Was Concomitant with Papillary Thyroid Carcinoma: A Case Report / 대한내분비외과학회지

Granular cell tumor (GCT) of the thyroid is rare and histogenesis of the carcinoma still remains poorly understood. Here in this study, we report a case of perithyroidal granular cell tumor in a 44-year-old woman, diagnosed as medullary carcinoma upon the interoperative frozen diagnosis. The tumor was comprised of white, solid mass with infiltrating margin in isthmus. Microscopically, the tumor revealed abundant eosinophilic cytoplasm, elongated nucleus and eosinophilic amyloid-like materials. It was composed of diffuse sheets of polygonal cells with abundant eosinophilic cytoplasm and cytologically bland nucleus on permanent section. On immunohistochemical staining, S-100 and CD68 are diffusely positive. Determining the progression and the behavior of the tumor is critical for providing long-term management and preventing aggressive treatment.

Gammagrafía con receptores de somatostatina en un caso de carcinoma medular de tiroides / Somatostatin receptor scintigraphy for thyroid medullary carcinoma: a case report

La gammagrafía con radiotrazadores que tienen afinidad por los receptores de somatostatina se ha convertido en metodología eficaz para el diagnóstico y estadificación de los tumores neuroendocrinos. Se presenta un caso en el cual el procedimiento radioisotópico muestra su efectividad en la localización del tumor primario.

Somatostatin receptor scintigraphy has become an important tool for diagnosis and evaluation of neuroendocrine tumors. This case report shows about the importance of the radionuclide procedure for the localization of the primary tumor.

Clinicopathological Characteristics and Prognostic Factors of Medullary Thyroid Carcinoma

BACKGROUND: Studies on the clinicopathological characteristics and prognostic factors of medullary thyroid carcinoma (MTC) in Korea are very rare. METHODS: We enrolled 56 MTC patients who underwent surgery at Samsung Medical Center from 1995 to 2006. We analyzed their gender, age at diagnosis, the pathologic findings, the TNM stage, the association with multiple endocrine neoplasia (MEN), RET protooncogene mutation and the, serum basal calcitonin levels before and after the surgery. We investigated the overall survival and the prognostic factors. RESULTS: The mean age at diagnosis was 46 years and the male/female ratio was 1:2.7. Fine needle aspiration cytology detected 61% of the MTC. The mean tumor size was 2.6 cm (range: 0.2-9.0 cm). Fifty-two percent of patients had the TNM stage more than III at the time of diagnosis. Distant metastasis was found in 5.3% (3/56) of the patients, either at the time of diagnosis or during the follow-up period. Hereditary MTC comprised of 23% of the patients and the disease developed at a younger age (38 years vs. 48 years, respectively, P < 0.05) with more bilaterality. RET protooncogene mutations were found in 27% (9/33) of the patients and most of them were in codon 634. After the primary surgery, the serum basal calcitonin levels were persistently elevated over 13 ng/L in 49% of the patients. The overall 5-year survival rate was 95.5%. Tumor size and distant metastasis were the significant prognostic factors for survival by univariate analysis (P < 0.05). CONCLUSION: There were no significant differences in the clinicopathological characteristics of MTC and survival in Korea compared to those of the Western countries.

Clinical Analysis of Medullary Carcinoma of the Breast / 한국유방암학회지

PURPOSE: Medullary carcinoma of the breast is a variant of breast cancer characterized by the histologic appearance of poorly differentiated cells surrounded by a prominent lymphoid stroma. Medullary carcinoma has been reported to carry a prognosis better than other invasive breast carcinomas, but it is frequently overdiagnosed due to the difficulty in diagnosis. The aim of this study was to assess the clinical manifestations and outcome of medullary carcinoma of the breast. METHODS: We reviewed the data of 91 patients diagnosed with medullary carcinoma and 3,743 patients with invasive ductal carcinoma, not otherwise specified (NOS) from January 1980 to December 2005 at Yonsei University Severance Hospital. The clinicopathologic features, disease free survival (DFS) and overall survival (OS) for patients with medullary carcinoma were compared with those of the NOS patients. RESULTS: With reviewing the pathologic slides, 69 (75.8%) patients had findings compatible with typical medullary carcinoma (TMC) and the remaining 22 (24.2%) patients were reclassified as atypical medullary carcinoma (AMC). Early stage cancer was more frequent at medullary carcinoma and lymph node positive cancer was less frequent at medullary carcinoma. The expression of ER/PR was positive in either the TMC (18.9%/16.2%) and AMC (15.0%/20.0%) as compared to the NOS (63.2%/57.2%), and the difference was significant (p<0.001). In contrast, the HER-2/neu expression rate was significantly higher in the TMC (47.4%) and AMC (45.5%) than in the NOS (28.3%, p=0.001). The 10-year disease free survival and 10-year overall survival of the atypical medullary carcinoma patients (67.8%, 77.8%) were in fact similar to the NOS carcinoma patients (68.3%, 74.7%). There was significant difference in 10-year disease free survival and 10-year overall survival between the TMC (77.8%, 86.0%) and NOS carcinoma (68.3%, 74.7%) patients (p=0.002, p=0.006). CONCLUSION: The clinical outcome of typical medullary carcinoma is favorable in spite of its aggressive pathologic features and it differs from atypical medullary carcinoma. For precise prediction of prognosis of medullary cancer, we should apply strict criteria for the diagnosis of subtype with medullary features.

Medullary carcinoma of the breast: Role of contrastenhanced MRI in the diagnosis of multiple breast lesions

Medullary carcinoma is a rare breast carcinoma with a syncytial growth pattern and high-grade cytology. It can be difficult to diagnose and may be missed on conventional imaging as the findings may overlap with benign lesions i.e. fibroadenomas. The authors report a case of a 25-year-old female who presented with multifocal breast lumps diagnosed with medullary carcinoma and fibroadenomas. Imaging and pathological correlation with contrast-enhanced MRI are presented in the diagnosis of these lesions.

Neurofibroma de tireóide em uma paciente com neurofibromatose tipo 1 / Neurofibroma of thyroid in a patient with neurofibromatosis type 1

A neurofibromatose tipo 1 (NF1), também conhecida como doença de von Recklinghausen, é uma doença autossômica dominante com alto grau de variabilidade da expressão clínica, comumente envolvida na formação de tumorações na maioria das vezes de origem benigna, localizadas principalmente na região da cabeça e do pescoço, sendo a tireóide acometida raramente. Porém existe na literatura a associação com carcinoma medular da tireóide (CMT), necessitando sempre sua exclusão. Relatamos o caso de uma paciente com NF1, com um nódulo de tireóide não-funcionante e sintomas obstrutivos. Foi realizada ressecção cirúrgica da lesão, com achados histopatológicos compatíveis com neurofibroma em tecido tireoidiano. A importância desse caso deve-se não só à raridade dessa apresentação da NF1, mas também à possibilidade de associação desta com CMT, tumor agressivo com possibilidade de cura pela ressecção cirúrgica.

The neurofibromatosis type 1 (NF1), also known as von Recklinghausen’s disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.

DNA Copy Number Changes in Thyroid Medullary Carcinomas Determined by Comparative Genomic Hybridization

BACKGROUND: A point mutation in the RET proto-oncogene, in medullary thyroid carcinoma (MTC) is well known, but no other genetic causes of MTC have been found. This study was performed to identify the most common DNA copy number changes in MTC by comparative genomic hybridization (CGH). METHODS: Twenty-nine surgically resected MTC specimens were retrospectively selected from patients operated on between 1996 and 2004 at the Asan Medical Center. A review of the clinical data and pathological findings was performed. Congored staining and immunohistochemical stains (calcitonin, chromogranin A and CEA) were processed by tissue microarray. CGH analysis was performed. RESULTS: The Congo-red stain was positive in only 12 cases. The immunohistochemical results were positive in 29 cases for chromogranin A, 26 cases for CEA and 25 cases for calcitonin. DNA copy number changes were found in 23 cases (79.3%). The most frequent change was a gain of 19q (65.5%); less frequent changes were gain of 22 (55.2%), 19p (51.7%), 16p (27.58%), 17q (17.24%), and loss of 4q (27.6%) and 3p (17.24%). CONCLUSIONS: DNA copy number changes of MTC were more common (79.3%) than reported in previous studies. The most frequent changes were gains in 19q, 22 and 19p.

Concurrence of Spatially Separated Medullary Carcinoma and Papillary Carcinoma of the Thyroid Gland: A Report of Three Cases

Although medullary thyroid carcinoma (MTC) may coexist with papillary thyroid carcinoma (PTC) as a collision tumor within the same nodule or as two or more spatially separated tumors, these two carcinomas rarely coexist. We encountered three cases of sporadic MTCs spatially separated from PTCs, which occurred concurrently, either within the same thyroid lobe or in different thyroid lobes. In each of the cases the patients underwent total thyroidectomy and neck dissection. PTC metastases of the lymph node were observed in two of the cases and MTC metastasis of the lymph node was observed in one case. Among the multiple thyroid nodules affected by both MTCs and PTCs, only the dominant nodules had spread to the lymph nodes. Because MTC has a different clinical significance from PTC, in patients with multiple thyroid nodules, appropriate diagnostic approaches, such as fine needle aspiration of all possible nodules and measurement of serum calcitonin level, should be performed.

Metastatic Medullary Carcinoma of Thyroid to Breast; A Case Initially Diagnosed as Primary Invasive Lobular Carcinoma: A Case Report

Metastasis to the breast from medullary carcinoma of the thyroid is extremely rare. We report a case of metastatic medullary carcinoma of the thyroid which presented as multiple breast masses with ipsilateral axillary lymphadenopathy in a 48-year-old woman. Six years ago, she underwent total thyroidectomy and neck dissection because of palpable neck masses, with a diagnosis of medullary thyroid carcinoma. Histological features of breast masses showed single- file or linear-cord arrangements, with plasmacytoid appearance, and the initial diagnosis was invasive lobular carcinoma. She underwent modified radical mastectomy. The tumor cells were diffusely positive for E-cadherin, calcitonin and thyroid transcription factor-1 (TTF-1) and were metastatic medullary carcinoma of thyroid. In the patients with a history of medullary carcinoma of the thyroid, a careful examination is necessary for a breast mass composed of solid and cord-like clusters of small round to ovoid cells with plasmacytoid appearance. Immunohistochemical staining for E-cadherin, calcitonin and TTF-1 could be helpful for differential diagnosis.

A Locally Advanced Breast Cancer with Difficult Differential Diagnosis of Carcinosarcoma and Atypical Medullary Carcinoma, which had Poor Response to Adriamycin- and Taxane-based Neoadjuvant Chemotherapy: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Atypical medullary carcinomas and carcinosarcoma have unique histopathological features. Here we present a case with a breast malignancy that had pathological characteristics of both. A 54-year old patient with a malignant breast mass received 6 cycles of adriamycin-based chemotherapy, followed by 3 cycles of paclitaxel monotherapy, and had a poor clinical response to treatment. A modified radical mastectomy was performed. The pathological diagnosis was complicated by an inability to distinguish between atypical medullary carcinoma and carcinosarcoma. The findings included a tumor that was well-circumscribed, high grade and a syncytial growth pattern as well as biphasic sarcomatous and carcinomatous characteristics. In conclusion, atypical medullary carcinoma and carcinosarcoma of the breast have entirely different prognoses and should be managed differently. Both should be treated by surgical resection, and additional therapy should be considered based on the cancer with the poorer prognosis.