Adenosarcoma of uterus in mother and mucinous carcinoma of breast in daughter: a rare case study

Adenosarcoma is an infrequent malignancy which consists of benign glandular epithelium and malignant mesenchymal component. We report a 63-year-old woman diagnosed with adenosarcoma with sarcomatous overgrowth of the uterine corpus, with history of mucinous carcinoma of the breast in her daughter. Although endometrial and breast cancers share few similar hormonal, reproductive and genetic risk factors, the association of endometrial cancer with breast carcinoma is not well established. 63 years old, P4L4, postmenopausal lady presented to our hospital with post-menopausal spotting, foul smelling vaginal discharge and pain abdomen for 1 week. After evaluation she underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy. Intraoperatively, a pedunculated fundal polyp measuring 6×7 cm distending the uterine cavity was noted. Post-operative histopathology examination was reported as adenosarcoma with sarcomatoid overgrowth of the uterine cavity. Immunohistochemistry revealed CK7 (epithelium (+), Vimentin (+), cluster of differentiation 10 (CD10) (+) and, Wilms tumor 1 (-). The possible association between these two conditions, adenosarcoma of uterus in mother and mucinous carcinoma of breast in daughter is explored and presented in this case report.

Mastalgia and associated breast diseases in a tertiary care center, Tamil Nadu: A cross-sectional study

Background: Mastalgia is the common breast condition among women. Mastalgia has highly variable prevalence which ranges 41–79%. It is more common in age group between 30 and 50 years. Mastalgia is approached according to its classification into three major categories, that is, cyclical pain, non-cyclical pain, and extra mammary pain. Breast pain ranges from mild to severe influencing the lifestyle of women affecting sexual relations, sleep pattern, and decreasing their daily life activities. Aim and Objectives: The aim of the study was to determine the incidence of benign and malignant breast disease in mastalgia. Materials and Methods: This cross-sectional study was conducted in Government Medical College, Sivagangai. Patients complaining of breast pain were examined. The data were compiled in an Excel worksheet, Epiinfo version 7.0 was used to analyze the data. Results: In our study, 100 patients complaining of breast pain were examined ranging from age 18 to 68 years. The mean age of the study population was 37.54 years and standard deviation of 9.077. Among 100 patients with mastalgia only 1 (1.64%) had malignancy which is insignificant and among rest 99 patients with mastalgia, 60.61% had benign breast diseases and 39.39% had no any breast lesions. Benign breast diseases are more commonly found in patients with mastalgia. Conclusion: Women having mastalgia can be reassured and some lifestyle modifications may aid the women. Hence, early detection of any breast disease in women having mastalgia and treating accordingly has considerable importance. Lifestyle modifications are needed in patients with mastalgia and they should come to facility to check and identify the issues and solve soon.

A prospective study of factors affecting seroma formation after modified radical mastectomy in patients of carcinoma of breast

Background: Seroma, a clinically evident subcutaneous collection of serous fluid after breast cancer surgery, developing in approximately 30% of cases. To prevent seroma formation, it is important to estimate individual risk of seroma formation, i.e., the identification of predictive variables will be helpful in designing future trials aimed at reducing the incidence of this seroma. This study intends to find out the association between certain pre-operative, intra-operative, and post-operative factors related to MRM and incidence of seroma formation.Methods: It was an observational prospective on 100 females undergoing MRM at Department of Gandhi Medical College Bhopal, Madhya Pradesh, India. Patients were observed postoperatively for seroma formation and factors affecting it.Results: patients with seroma formation in this study tended to be older age (age, 62.60±10.40 years versus 56.13±10.31 years; p<0.001) and more obese (BMI, 26.95±4.2 versus 24.61±3.61; p<0.001). Higher amount of initial drain volume was directly related to seroma formation.  Initiation of arm physiotherapy after surgery (3.14±0.23 days versus 2.17±0.74 days; p=0.043).Conclusions: The incidence of seroma is higher in older and in more obese patients. The incidence is decreased by flap fixation under muscles and early physiotherapy. Furthermore, few interventions in the operative period can help minimize the chances of seroma formation.

Clinical profile of carcinoma breast patients in working women population in a metro city

Background: In India, breast cancer is the second most common malignancy among women next to carcinoma of cervix. Since it present as a painless lump patient often neglect and present to hospital late. With increasing prominence and greater visibility in country specific health profiles around the world, breast cancer and its prevention detection and treatment will continue to emerge as a major priority and challenge for health system. As carcinoma of breast is a quite common clinical problem encountered in clinical practice, this study was an attempt to study clinical presentation modes of management of the disease.Methods: 50 patients who were admitted with a diagnosis of carcinoma breast were studied though history taking, clinical examination, relevant investigations depending on the stage of the disease. After completion, the results were analysed using Microsoft excel software and are compared with other studies.Results: Majority of patients belonging to age group 41-50 years (42%) with lump as major complaint at the time of presentation (78%). Disease in most patients was on upper outer quadrant (78%). Majority of patients belong to stage II (84%) of the disease clinically.Conclusions: The simple and effective methods of detecting the disease early like self-breast examination, clinical breast examination, ultrasonography, mammography, fine needle aspiration cytology should be made aware among the people for early detection and effective treatment of the disease.

A cross-sectional study on the pattern of recurrence in carcinoma breast patients based on molecular subtypes

Background: Breast cancer is a major public health issue and it is the leading cause of cancer related death in females worldwide. New insights in the cancer treatment led to considerable improvement in the survival of cancer patients. But metastasis remain an area were all sorts of conventional treatments fails and it is the cause of death of most carcinoma breast patients. In this study we aim to establish a possible link to local recurrence and distant metastasis with different biological subtypes of breast cancer.Methods: One hundred and eighty patients of carcinoma breast patients of carcinoma breast who presented with local recurrence or distant metastasis in the period of January 2018 to March 2019 in Government Medical College, Thiruvananthapuram were included in this study. These data were collected from the hospital records.Results: Local recurrence was most seen in triple negative (50%) subtype followed by HER2 (32.1%) enriched. Local recurrence was least among luminal A (13.8%) with a p value of 0.001. Bone metastasis was the most common type of metastasis and was most seen in luminal A (p=0.001). Triple negative had the maximum CNS metastasis with a p value of 0.003. Liver metastasis was seen mostly in luminal B (26.2%) and A (20.7%) and lung metastasis in triple negative (13.5%) and HER2/neu (10.7%). However, there was no significant association for lung or liver metastasis to any subtype.Conclusions: Biological subtypes of breast cancer classified by immunohistochemical expression of ER, PR, HER2, Ki 67 show different clinicopathological features, recurrence pattern, and survival outcomes.

Study of clinical, imaging and pathological assessment of breast lumps: an observational study

Background: A palpable lump in a woman’s breast could be benign or malignant and it requires prompt evaluation to confirm or exclude cancer. This study aims to establish the correlation between clinical and radiological parameters for provisional diagnosis of breast lumps and the role of histopathology for final diagnosis of these breast lumps.Methods: Total 275 female patients with palpable breast lumps were included in the study, where a detailed history was recorded and clinical examination was done. All patients underwent ultrasonography of the breast along with fine needle aspiration cytology or histopathology, wherever indicated.Results: Benign breast lumps were found more commonly in 18-30 years of age group whereas malignant breast lumps were seen more commonly in the 41-60 years age group and the incidence increased with age. Fixity to skin was present in 5.1% and fixity to chest wall was present in 5.8% respectively, and all of these cases turned out to be malignant.Conclusions: Attributing factors for suspicion of malignant lumps are advanced age, fixity to surrounding structures, presence of ulceration and peau’d orange breast skin appearance. Although for confirmation of malignancy from a suspected breast lump requires either cytology or histopathology of the excised specimen.

Clinical Correlation of Maximum Standardised Uptake Value (SUVmax) in Positron Emission Tomography- Computed Tomography (PET-CT) with Initial Disease Staging of Carcinoma Breast- An Observational Study at Indian Tertiary Care Centre

The most common primary malignant disease in the world amongst women is carcinoma breast. Metabolic activity of a lesion (SUVmax) has strong clinical correlation with various prognostic factors according to numerous literature reviews. The main aim of this study is to assess the correlation between maximum Standardized Uptake Value [SUVmax] and initial disease staging (as per AJCC TNM-8th edition). We wanted to study the correlation between metabolic activity [SUVmax] of the primary tumour in breast carcinoma, and size of the primary, nodal and distant metastatic status.METHODSThis is an observational study conducted over a period of two years in breast cancer patients [n=139] undergoing PET-CT as a part of initial staging. PET-CT was done using Siemens Horizon True-V PET according to institutional protocols.RESULTSSignificantly higher SUVmax values were observed in tumours with larger size [>2 cms]. However, there was no significant correlation between SUVmax of primary tumours and the status of axillary nodal involvement and distant metastases [p = 0.125 and 0.847 respectively].CONCLUSIONSMetabolic activity of primary breast cancer has strong clinical correlation with size; however, there is no such correlation found in nodal and metastatic spread of the disease.

A Study to Evaluate the Relevance and Validity of Triple Assessment in Diagnosing Carcinoma Breast.

Breast cancer is the second leading cause of cancer related deaths. Breast cancer survival is strongly determined based on the stage of the cancer after diagnosis. This demonstrates the benefits of early detection of breast cancer in keeping survival rates of patients higher. Triple Test that comprises clinical examination, radiological assessment (USG/Mammography) and FNAC is considered as the gold standard in diagnosing carcinoma breast. This study aimed at diagnosing carcinoma breast in patients with the help of triple assessment and studying its relevance and validity.METHODSWomen who presented with a lump in breast to surgery OPD in the department of general surgery, NMCH, Patna were included in the study. This is a prospective study undertaken from December 2017 to November 2019. After taking informed consent from the study participants, they were thoroughly examined, and detailed history was taken. Subsequently, they were subjected to other components of triple test, so that a definitive diagnosis could be formed. Cases of breast abscess and those with fungating or ulcerative mass were excluded from the study.RESULTSClinical examination had a sensitivity of 90% and specificity of 86.66%. FNAC had a sensitivity of 95% and specificity of 96.66%. Radiological assessment when used alone, yielded a sensitivity of 90% and specificity of 96.66%. The sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 96.66% respectively. The positive predictive value was 95.23% and negative predictive value was 100%. The p value was highly significant (<0.0001).CONCLUSIONSTriple assessment is an important diagnostic tool in the assessment of carcinoma breast and is better than either of the modalities used alone.

To Compare the Effects of Adjuvant and Neoadjuvant Chemotherapy on Outcome of Stage III Carcinoma Breast.

At present, the ideal treatment of patients diagnosed to have carcinoma breast includes multimodal treatment therapy. However, the sequence of various modalities in the treatment of breast cancer varies according to the stage of the tumour at the time of presentation. Early breast cancer cases first undergo surgical treatment modality before systemic therapies, while advanced cases should undergo systemic therapies first followed by surgical interventions if possible. However, treatment of stage IIIA and IIIB patients (locally advanced disease) but having an operable lump poses a dilemma of whether to go for surgery first or systemic therapy first. We wanted to compare the outcome in terms of metastasis/recurrence between adjuvant and neo-adjuvant chemotherapy in selected cases of stage IIIA and stage IIIB carcinoma breast for a follow-up period of 1 year at a tertiary care hospital in central India.METHODSThis is a comparative observational study conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH) of Jawaharlal Nehru Medical College from October 2017 to Sept 2019, which included patients of TNM stage IIIA and IIIB breast carcinoma, half of whom were treated with adjuvant chemotherapy and other half treated with neoadjuvant chemotherapy along with standard surgical procedure like MRM/toilet mastectomy.RESULTSDistribution of patients according to presence of lymphovascular Invasion was done which was statistically non-significant. However, when disease recurrence or disease metastasis/mortality was compared with lymphovascular invasion in neo-adjuvant group, it was found to be statistically significant (p value=0.022) In the adjuvant group 90 % of patients belonged to stage IIIA while in neo-adjuvant group only 50 % patients belonged to stage IIIA. Rest patients in both group belonged to stage IIIB. This difference in adjuvant and neo-adjuvant group was statistically significant. (p=0.022) In comparison of outcome in both adjuvant and neo-adjuvant chemotherapy, 5% patients of adjuvant group developed metastasis and died succumbing to it while another 5 % developed recurrence during follow up. In the neo-adjuvant group 35% patients developed distant metastasis or died due to disease while another 5 % patient developed local recurrence in axilla for the disease. This difference in the outcome of two groups was statistically significant with p value of 0.013.CONCLUSIONSIn our study we found that for a locally advanced breast cancer patient (stage IIIA &B) with an operable breast lump, adjuvant chemotherapy is superior than neo-adjuvant chemotherapy with a significant p value of 0.013. Superior in terms of lesser distant metastasis/recurrence when we followed up the patient for 1 year after the completion of treatment.

Synchronous occurrence of lobular breast carcinoma and granulosa cell tumor of ovary mimicking metastatic lobular breast carcinoma

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

Correlation of Expression of Estrogen Receptor, Progesterone Receptor and Human Epidermal Growth Factor Receptor-2 with Histopathological Grade in Cases of Carcinoma Breast

Introduction: Breast carcinoma is the most common canceramong women in both developing and developed countries.It needs alarming attention because it causes high morbidityand mortality. There is a need to understand the initiationand progression of breast cancer on hormonal, cellular andmolecular basis which forms the platform for designing oftargeted therapy. This study was intended to find correlationbetween the expression of Estrogen receptor, Progesteronereceptor and Human Epidermal Growth Factor Receptor-2with histological grade in cases of carcinoma breast.Material and methods: This study was conducted in theDepartment of Pathology at Bhagat Phool Singh GovernmentMedical College for Women, Khanpur Kalan, Sonepat on 55histologically confirmed breast cancer cases.Results: The age of the patients ranged from 27 to 70 yearsand the mean age was 51.56 ± 11.39 years. Invasive ductalcarcinoma - no special type was the most common histologicaltype(92.72%). The most common histological grade observedwas grade II i.e. 61.82%. Lymph nodes involvement was seenin 55.32% of the cases. ER, PR and HER-2/neu positivitywas observed in 45.45%, 47.27% and 25.45% of the casesrespectively. ER and PR were found to correlate withhistological grade (p<0.05) while no correlation was observedbetween HER-2/neu and histological grade(p>0.05).Conclusion: Evaluation of ER, PR, and HER-2/neu statusshould be incorporated routinely as a part of histopathologyreports in all cases of breast carcinoma as they not onlyhelp in assessment of prognosis, but also help in decidingmanagement and improving overall survival.

Conventional Radiotherapy with Hypofractionated Radiotherapy in Post-Mastectomy Breast Cancer Patients: A Prospective Comparative Study

Aim: The aim of this study is to assess the efficacy, toxicity, and feasibility of hypofractionated radiotherapy in post-mastectomybreast cancer patients compared with conventional radiotherapy.Materials and Methods: A total of 80 post-mastectomy breast cancer patients were randomized into two groups for adjuvantradiotherapy. Control group of 40 patients received conventional radiotherapy of 50 GY in 5 weeks. Study group of 40 patientsreceived hypofractionated radiotherapy of 42.72 GY in 3.1 weeks.Results: The statistical analysis of the study was performed in terms of tolerability, radiation toxicities, and feasibility of thehypofractionated radiotherapy over conventional radiotherapy. There was found to be no significant difference between thetwo groups.Conclusion: In breast cancer patients after post-mastectomy, hypofractionated radiotherapy in comparison to conventionalradiotherapy finds comparable outcomes without any significant difference in radiation-induced toxicities.

Role of Axillary Radiotherapy in Patients of Locally Advanced Carcinoma Breast with Inadequate or unknown Lymph Node Dissection Status - An Institutional Audit

Introduction: Loco-regional radiotherapy to supraclavicularand Axillary region has been the standard of care for treatmentof locally advanced carcinoma breast without or doubtfulaxillary clearance. We did a clinical audit of the patient careprovided and the outcome of the same relating to loco-regionalradiotherapy for such patients at a district medical college inIndia.Material and methods: All patients with locally advancedcarcinoma breast between 2007 and 2013 who had treatmentin the Department of Radiotherapy were audited. The patientswere stratified as per surgery they had and pathologicalinformation that was available in their post op HPE reportalong with type of radiotherapy they received. The analysiswas done with IBM SPSS V23.Results: over the period of 6 years there were 874 patientsof carcinoma breast registered in the Department. Out ofthem 246 were metastatic. 12 were early breast carcinomas,rest 616 were LABC who had indications of Supraclavicularand Axillary RT due to any reason. Out of these 616 patientsthe indication in 592 patients was lack of pathologicalinformation in terms of number of nodes dissected beinglesser than 10. 138 of them were referred from other centerswhere Radiotherapy was not available and therefore theyfollowed up at other centers. 77 patients never completed theirtreatment (radiotherapy or chemotherapy). Additionally 42patients never came for any follow up after their treatmentcompletion. A total of 359 analyzable patient records werefound who had at least one follow up.Conclusion: In our audit due to limited resources nearly 63%of the patients received RT only chest wall and supraclavicularregion RT. However it did not change the loco-regionalfailure rate at 5.3 years. A longer follow up data of 10 yearsis necessary to see whether this trend is continued to OS.However the present retrospective data provides a startingpoint for prospective clinical trials to look if certain groupof patients may benefit from omitting Axillary Radiotherapyeven when the dissection had yielded lesser than 10 nodes

Transfusion Requirement in Thrombocytopenia Observed in Patients with Carcinoma Breast Undergoing Chemotherapy

Introduction: Breast cancer is the commonest cancer inurban Indian females, and the second commonest in the ruralIndian women. The estimated number of breast cancer casesin India during 2012 was 145,000 cases with an incidencerate of 25.8 per 100,000 women. In Kerala, Breast cancer hasan annual incidence of 14.9/100,000 population. This studywas carried out with an objective to identify the proportion ofthrombocytopenia and the requirement of platelet transfusionsin these patients.Material and methods: This was a hospital based prospectivestudy, done in the Department of Transfusion medicine fora period of one and a half years from January 2016 to June2017. As per the inclusion criteria 125 consecutive cases whounderwent chemotherapy for Carcinoma Breast at Departmentof Radiotherapy, Govt. Medical College, Thiruvananthapuramwere included for the study. The requirement of platelettransfusions were assessed in these patients. Data wasanalysed with SPSS software (version 21).Results: Among the 125 patients, thrombocytopenia wasnoticed in 5.4% study population in prechemotherapy phase,majority having only grade I thrombocytopenia. In Postchemo phase thrombocytopenia was observed in 11.2% of thestudy group, grade I thrombocytopenia in 8.8% and grade IIthrombocytopenia 2.4% of patients. Platelet transfusion wasrequired in 5.4% of the patients during chemotherapy.Conclusion: Due to the high prevalence of chemotherapyinduced hematological complications, even mild degrees ofthrombocytopenia should be detected and evaluated beforecommencing chemotherapy. Platelet transfusion should bereserved for patients who were really required. This studygives an insight regarding the proportion of thrombocytopeniain patients with carcinoma breast undergoing chemotherapyand their platelet transfusion requirements, which will help intaking care of these patients and inventory management of theblood banks.

Expression of ER, PR and HER 2 Receptor Status in Breast Carcinomas and its Correlation with Histopathological Grading

Introduction: Breast cancer is the most common cancer in women in developed countries. In India; it is second to cancer of cervix among women. Several histopathological features have prognostic significance in breast carcinoma which includes histologic subtype, grade, lymph node status, ER/PR status, Growth factors and its receptors, proliferation activity and DNA content, oncogenes and tumor suppressor genes. The Immunohistochemistry (IHC) classification provides both therapeutic and prognostic information. Aim and objectives: To assesses the ER/PR status and HER -2 status of breast carcinoma, to correlate the ER/PR and HER-2 receptors status with modified Bloom- Richardson histological grading, and clinico pathological parameters. Materials and methods: This study was undertaken over a period of 2 years from August 2013 to July 2015 in the Department of Pathology, Chalmeda Anand Rao Institute of Medical Sciences. Total of 75 cases of carcinoma breast in females diagnosed histopathologically, belonging to age group of 21-85 years were included in the study. Pingle Prathyusha, Radhika Mucharla, V. Srinivas Kumar, Geeta Voolapalli, Thota Ravinder. Expression of ER, PR and HER 2 Receptor Status in Breast Carcinomas and its Correlation with Histopathological Grading. IAIM, 2019; 6(7): 49-58. Page 50 Results: Histopathological grading was done according to Modified Bloom Richardson’s grading. 27(36%) cases were of grade II and 24(32%) cases each were of grade I and grade III. ER and PR were positive in 76% and 58.7% of tumors respectively. HER-2 over expression (score 2+ & 3+) was seen in 44% of tumors and was negative (0 or 1+) in 56% of tumors. Among the most common histologic subtype i.e., IDC (NOS), ER, PR and HER-2 were expressed in 75.36%, 60.86% and 44.92% respectively. Tumors with ER/PR-, HER2+ subtype were larger (>5cms), 1(1.3%) each medullary and apocrine carcinoma were positive for HER-2. None of the lobular, mucinous and papillary carcinoma expressed HER-2. Statistically significant values were noted for histologic grade immunohistochemical sub types, lympho vascular invasion and nuclear pleomorphism. Conclusion: In this study ER, PR and HER-2 receptors status correlates well with histopathological grading and other clinico-pathological parameters. These assays have the advantage of allowing only tumor cells to be assessed for receptor status. They can be conducted relatively inexpensively on routinely processed tissue sections with no need for specialized equipment.

Clinicopathologic features of secretory breast carcinoma / 中华肿瘤杂志

Objective@#Investigate the clinicopathological features for secretory carcinoma of breast (SCB).@*Methods@#The clinical data of 3 SCB cases were collected, immunohistochemical staining was performed by the streptavidin-peroxidase (SP) method to test the expression of the antibodies: ER, PR, HER-2, Ki-67, S100, CK5/6, p63, SMA, calponin, GCDFP-15, and EGFR. Fluorescence in situ hybridization (FISH) was used to detect the ETV6-NTRK3 gene fusion.@*Results@#ER was focal weakly positive in case 1 and case 2 (about 5%) , and negative in case 3. PR was focal weakly positive in case 1 (about 5%) and completely negative in case 2 and case 3. Three cases showed that HER-2, SMA, calponin, GCDFP-15 were negative, while S100, CK5/6, EGFR were diffuse strongly positive. The proliferation index was nearly 15% in case 1 and case 2, and 10% in case 3. p63 was negative in mostly tumor cells of case 1, and focal positive expression in the nucleus and cytoplasm. In case 2, p63 was completely negative. However, p63 was observed positive in the cytoplasm as well as some secretory material in case 3. ETV6-NTRK3 gene fusion detection by FISH was positive in all cases.@*Conclusions@#SCB is a rare low grade triple-negative breast cancer with the unique pathomorphologic features, while its recurrent t (12; 15) (p13; q25) translocation resulting in ETV6 -NTRK3 gene fusion. It has the indolent clinical behavior and good prognosis.

BREAST METASTASIS OF A CUTANEOUS SQUAMOUS CELL CARCINOMA: CASE REPORT / Carcinoma escamocelular metastático para mama: relato de caso

Breast cancer is the most frequent malignant tumor in women. However, squamous cell carcinoma (SCC) of the breast is very rare. Several pathological criteria are required to establish a firm diagnosis of primary SCC of the breast: 1) the tumor origin must be independent from the overlying skin and nipple; 2) the infiltrating component of the breast cancer must be predominantly of squamous type (>90%); 3) no other invasive neoplastic elements, ductal, mesenchymal or otherwise, must be present in the tumor; 4) another site of primary SCC in the patient must have been excluded. The metastatic lesion involving the breast may occur due to a metastasis from a contralateral mammary cancer or originate in any extramammary site. Breast metastases do not normally express estrogen, progesterone receptors or Human Epidermal growth factor Receptor-type 2 (HER2) protein. Prognosis is poor and treatment is palliative, based on systemic therapy tailored to the primary cancer, sometimes completed by comfort locoregional treatment of the breast lesion. The present study reports the case of a woman previously treated for cutaneous SCC with breast metastasis, but more studies of these rare tumors are needed to increase our knowledge and improve patients' outcomes

O câncer de mama é o tumor maligno mais frequente em mulheres, no entanto o carcinoma epidermoide primário da mama é muito raro. Vários critérios patológicos são necessários para estabelecer o diagnóstico de carcinoma de células escamosas (CEC) primário da mama: 1) a origem do tumor deve ser independente da pele sobrejacente e do mamilo; 2) o componente infiltrante deve ser predominantemente de tipo escamoso (>90%); 3) nenhum outro elemento neoplásico invasivo, como ductal ou mesenquimal, deve estar presente no tumor; 4) um sítio primário de CEC deve ter sido excluído. Já os tumores secundários na mama podem ocorrer em razão de tumores na mama contralateral ou ter origem em praticamente qualquer sítio extramamário. As metástases para mama, normalmente, não expressam receptores de estrogênio nem de progesterona ou proteína Human Epidermal growth factor Receptor-type 2 (HER2). O prognóstico, na maioria dos casos, é pobre e o tratamento paliativo, com base na terapia sistêmica adaptada ao câncer primário, às vezes completada pelo tratamento locorregional da lesão mamária. O presente trabalho relata o caso de uma mulher previamente tratada por carcinoma escamocelular de pele, evoluindo com metástase para mama, porém mais estudos sobre esses tumores raros são necessários para aumentar o conhecimento e melhorar os resultados obtidos por esses pacientes.

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

Low serum 25-hydroxy vitamin D levels are associated with aggressive breast cancer variants and poor prognostic factors in patients with breast carcinoma

ABSTRACT Objective: This study was conducted to assess the serum 25-hydroxy (OH) vitamin D levels in patients with breast cancer compared to healthy controls and to identify its association with aggressive breast cancer phenotypes. Materials and methods: Serum 25-OH vitamin D levels of 78 breast cancer patients and 78 matched healthy controls were estimated using ELISA. The cases and controls were matched with respect to age, menopausal status, parity, weight, height and co-morbidities. Prognostic factors like grade of tumour, hormone receptor status, HER2 neu status and lymphovascular invasion were compared with 25-OH vitamin D levels. Results: The mean serum 25-OH vitamin D levels of cases were significantly lower compared to the controls (22.33 ± 8.19 vs. 37.41 ± 12.9 ng/mL; p = 0.0001). Patients with higher grades of tumour, non-luminal types of breast cancer and breast cancers with estrogen receptor negativity had significantly lower serum 25-OH vitamin D levels than their opposing groups. Patients with excellent and good Nottingham's prognostic Index (NPI) had significantly higher serum 25-OH vitamin D levels than the moderate and poor NPI groups. Conclusion: Newly diagnosed breast cancer patients have significantly lower serum 25-OH vitamin D levels than healthy controls. Lower level of serum 25-OH vitamin D correlates with aggressive breast cancer phenotypes.

Comparison of lymphangiogenesis, lymphatic invasion, and axillary lymph node metastasis in breast carcinoma

Context: Lymphangiogenesis correlates with poor prognosis in Invasive Ductal Carcinoma (IDC) breast. D2-40 antibody, a specific marker for lymphatic endothelium, differentiates lymphatic from vascular endothelium. Therefore, the aims of this study were to estimate lymphangiogenesis using D2-40 antibody and correlate with lymphatic invasion (LI) and axillary lymph node (LN) status and compare lymphatic mean vessel density (LMVD) with Tumor (T) and Node (N) stages and grade of tumor. Methods and Material: The study was conducted on fifty consecutive cases of IDC breast who underwent modified radical mastectomy (MRM) from Jan 2009 to March 2011. Hematoxylin-eosin sections and Immunohistochemistry (IHC) slides were studied along with their LN status. LMVD was counted after D2-40 immunostaining (100x magnification) in three hot spots in peritumoral areas and averaged. LI as opposed to vascular invasion (BVI), and LN status for all cases were assessed. Statistical Analysis: Statistical analysis was done using SPSS software (version 14.0 for Windows). Pearson's correlations, χ2 tests and Mann-Whitney U test were used. Results: Lymphangiogenesis varied from 0 to 58 with mean LMVD of 11. Of 50 cases, five showed no lymphatic vessels in peritumoral areas; of these five, three had positive LNs. 21/50 cases had LI. No statistical significant association was seen between lymphangiogenesis and LI. 34/50 cases had positive LNs. Mean LMVD was higher in patients with N2/N3 stage as compared to N0/N1 stage and was statistically significant (P = 0.013). Conclusions: D2-40 is specific marker for lymphatic endothelium. LI and lymphangiogenesis, as opposed to BVI, are better prognostic indicators in IDC breast.