Lobular Carcinoma in Situ with Atypical Mass Presentation: a Case Report / Carcinoma lobular in situ com apresentação nodular atípica: relato de caso

Lobular carcinoma in situ (LCIS) is associated with an increased risk of breast cancer and accounts for 1 to 2% of all breast cancers. LCIS diagnosis currently remains one of the major identifiable risk factors for subsequent breast cancer development. Imaging methods are becoming increasingly sensitive, and the consequent detection of small lesions and subtle abnormalities increases the chance of detection of in situ and invasive carcinomas, leading to a reduction in mortality. This report describes a case of a palpable complaint with abnormal imaging findings, including a solid LCIS mass.

O Carcinoma Lobular in situ (CLIS) está associado a um aumento do risco de câncer de mama e representa 1-2% de todas as neoplasias mama. Atualmente, o diagnóstico de CLIS continua a ser um dos maiores fatores de risco identificáveis para o posterior desenvolvimento de câncer de mama. Os métodos de imagem estão cada vez mais sensíveis, fazendo com que a detecção de pequenas lesões e anormalidade sutis aumentemo risco de detecções de carcinomas in situ e invasivos, levando a diminuição da mortalidade. Neste relato será descrito um caso de queixa clínica palpável com alteração de achados de imagem como massa sólida de CLIS.

Metástasis enoftalmiantes de la órbita: una excepción a la regla / Enophthalmos due to orbit metastasis: an exception to the rule

De los tipos de cáncer que metastatizan la órbita, el de la mama, el pulmon y la próstata ocupa un lugar preeminente. En ocasiones el diagnóstico del tumor primario permanece elusivo a pesar de una evaluación exhaustiva. La mayoría de las veces producen proptosis ocular y son fácilmente detectados. En otras producen todo lo contrario, enoftalmía, haciendo entonces el problema menos aparente y el diagnóstico elusivo. La metástasis mamaria enoftalmiante de la órbita es un raro evento y debe ser considerada como un diagnóstico diferencial inicial en mujeres maduras con enoftalmía no traumática. En elpresente trabajo presentamos una serie de ocho pacientes con carcimona lobulillar infiltrante y escirroso de la órbita productor de enoftalmía, describimos sus características clínicas y hacemos notar su mal pronóstico vital

Of the types of cancer that metastatize the orbit, the breast, lung and prostate occupy a pre-eminet place. Sometimes the diagnosis of the primary tumor remains elusive despite a thorough assessment. Most of the times produce eye proptosis and are easily detected. In other cases they produce just the oppsite, enophthalmos, then doing the problem least apparent and the diagnosis elusive. Enopthalmos and breast metastasis are a rare event and should be considered as an initial differential diagnosis in especially in mature women with non-traumatic enophthalmos. In this paper we present a series of eight patients with infiltrating lobulillar and scirrous carcinoma of the orbit producing enophthalmos, we described their clinical features and do note their poor vital prognosis

Bilateral multiple extraocular muscle metastasis from breast carcinoma.

We report a rare presentation of an initially misdiagnosed case of a pseudotumor, which on histopathology was diagnosed as bilateral breast metastases of lobular carcinoma involving multiple extraocular muscles. A 61-year-old lady presented with external ophthalmoplegia and diplopia. Incisional biopsy was performed using a lid crease approach and the patient received radiotherapy and hormonal therapy. Following prolonged hormonal therapy, complete remission was achieved, with improvement in ocular motility and resolution of diplopia, about 18 months after the initial presentation. Multiple extraocular muscle involvement by breast carcinoma metastasis is very rare and should be considered in the differential diagnosis, especially in patients with a prior history of breast carcinoma.

Inmunodetección de FHIT y E-cadherina en fibroadenomas y cáncer ductal y lobulillar de mama / Inmunodetection of FHIT and E-cadherin in fibroadenomas and ductal and lobular human breast cancer

En Chile, el cáncer es la segunda causa de muerte después de las enfermedades cardiovasculares. Los principales cánceres asociados a muerte en mujeres fueron mama, estómago, vesícula biliar, broncopulmonar y cérvico uterino. Alteraciones de las E-cadherinas han sido relacionadas con varios tipos de cáncer, ya que uno de los principales eventos involucrados con su disfunción es el gatillar la invasión y metástasis del tumor. La inactivación del gen CDH1 ha sido demostrada en el cáncer gástrico difuso y el cáncer de mama lobulillar. Asimismo, la inactivación del gen FHIT parece estar asociado con la progresión a neoplasias más agresivas. Se realizaron determinaciones inmunohistoquímicas (IHQ) en fibroadenomas mamarios y cánceres previamente diagnosticados por RE, RPg y Her2, mostrando positividad en todos los casos. La detección (IHQ) de la expresión de FHIT y E-cadherina en tejidos con patologías benignas y malignizados, puede aportar una importante información diagnóstica y pronóstica en el cáncer de mama.

In Chile, cancer is the second leading cause of death after cardiovascular diseases. The major death-related cancers in women were breast, stomach, gallbladder, lung and cervical cancer. Alterations of E-cadherin have been linked to various cancers, as one of the main events involved in its dysfunction is the trigger of tumor invasion and metastasis. CDH1 gene inactivation has been demonstrated in diffuse gastric cancer and lobular breast cancer. Furthermore, inactivation of the FHIT gene to be associated with progression to more aggressive tumors. Immunohistochemistry (IHC) determinations were performed in fibroadenomas and breast cancers previously diagnosed by ER, PgR and Her2, showing positivity in all cases. Immunohistochemical detection of FHIT and E-cadherin expression in tissues with benign disease and malignant, may provide an important diagnostic and prognostic information in breast cancer.

Differential expression of e-cadherin in lobular and ductal carcinoma of breast in an Iranian Cancer Care Hospital

To determine the role of E-cadherin in differentiating Breast lobular carcinoma from Breast ductal carcinoma in Iranian patients. A total of 80 malignant breast samples were reviewed by two pathologists before undergoing E-cad immunohistochemistry [IHC] staining. The results from IHC were compared with the results from the morphological study of the samples and they were then analyzed statistically. The normal ductal cells had strong complete homogenous membrane E-cadherin reactivity in all cases. The complete absence of E-cadherin membrane staining occurred in 14 out of 16 cases of Lobular breast carcinoma. The mean score of E-cadherin expression in ductal carcinoma was 191.35 with a CVof 104.39. In lobular carcinoma, the mean score of E-cadherin was 9.36 with a CV of 25.68. Using the Mann-Whiteny test, the difference between E-cadherin expression score in ductal and lobular carcinoma was statistically significant [P=0.0009]. E-cadherin expression is a useful diagnostic tool in distinguishing ductal from lobular carcinoma of breast

Aspectos clínicos e radiológicos do carcinoma lobular invasivo de mama / Clinical and radiological features of invasive lobular breast carcinoma

Carcinoma lobular invasivo (CLI) é o segundo tipo histológico mais comum de câncer de mama e a sua incidência vê aumentando continuamente ao longo das últimas décadas. Seu padrão de crescimento insidioso e infiltrativo parece contribuir para a dificuldade na detecção precoce e explica sua apresentação atípica no exame físico. Assim, os exames de imagem apresentam papel fundamental para o diagnóstico e manejo do CLI. O objetivo deste artigo é apresentar os aspectos histológicos e clínicos desse tumor de difícil diagnóstico, bem como a sua apresentação radiológica nos principais exames de imagem.

Miofrioblastoma mamário em axila / Mammary myofibroblastoma in axila

Miofibroblastoma é um tumor benigno raro de mama, de origem mesenquimal. A localização em região axilar é ainda mais incomum. Tendo em vista a dificuldade em se estabelecer o diagnóstico diferencial baseado apenas nos achados clínicos e imaginológicos, a confirmação histopatológica é imprescindível no diagnóstico diferencial com tumor oculto de mama.

Myofibroblastoma is a rare and benign mesenchymal breast neoplasm. The axillary topography is further more uncommon. The histologic identification is important because the differencial diagnosis with malignant tumours of the breast. This report a case of mammary myofibroblastoma in axilla, wich was initially diagnosticated as an occult lobular carcinoma.

Carcinoma mamário dentro de fibroadenoma: relato de dois casos / Breast carcinoma within fibroadenoma - two cases reports

O fibroadenoma é um tumor benigno mais comum da mama. Trata-se de neoplasia mista com componentes epiteliais e estromais. As taxas de frequencia de malignização do componente epitelial do fibroadenoma referidas na literatura são muito baixas (0,3%). Na maioria das vezes o carcinoma associado a fibroadenoma apresenta-se no estágio in situ e tem bom prognóstico. O objetivo deste trabalho é descrever dois casos clínicos de carcinoma dentro de fibroadenoma atendidos no Hospital do Câncer – Instituto do Câncer do Ceará (ICC). Primeiro caso: paciente, 51 anos, submetida à excisão local de nódulo à direita. O anatomopatológico evidenciou fibroadenoma associado a carcinoma lobular in situ. Segundo caso: paciente 42 anos mastectomizada à esquerda em 2005, apresentou nódulo em mama direita cuja punção guiada por ultra-sonografia foi compatível com carcinoma. Submeteu-se a quadrantectomia com pesquisa de linfonodo sentinela. O estudo histopatológico demonstrou carcinoma ductal in situ dentro de fibroadenoma e em tecido periférico.

Fibroadenoma is the most common benign tumor of the breast. It is a mixed neoplasm with epithelial and stromal components. Malignancy rates for the epithelial component reported in the literature are very low (0.3%). Usually carcinomas associated with fibroadenomas are in the in situ stage and have a favorable prognosis. The objective of the present paper was to report two clinical cases of carcinoma arising in fibroadenoma in patients attending the Ceará Cancer Institute (Fortaleza, Brazil). Case 1: 51-year old patient submitted to local excision of node in the right breast. The pathoanatomical examination revealed fibroadenoma associated with lobular carcinoma in situ. Case 2: 42-year old patient with left breast mastectomized in 2005 presenting with node in the right breast. Ultrasound-guided biopsy compatible with carcinoma. The patient was submitted to quadrantectomy and sentinel lymph node biopsy. The histopathological examination revealed ductal carcinoma in situ arising in fibroadenoma and peripheral tissues.

Targeted Ultrasound for MR-Detected Lesions in Breast Cancer Patients

OBJECTIVE: To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US. MATERIALS AND METHODS: One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification. RESULTS: Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision. CONCLUSION: Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.

Carcinoma lobular invasivo no homem / Invasive lobular carcinoma in men

Os autores relatam um caso de carcinoma lobular invasivo em homem, ocorrência extremamente rara nesse sexo, enquanto corresponde a aproximadamente 10% dos carcinomas mamários femininos. Revisamos a literatura e encontramos 22 casos, apenas 1 publicado no Brasil, em 1997.

The authors report a case of invasive lobular carcinoma in man, which is extremely rare, while accord approximately 10% of breast cancers in women. We reviewed literature and found 22 cases, which of just one published in Brazil in 1997.

Cytological features of lobular carcinoma of breast: how important are the intracytoplasmic lumina?

Lobular carcinoma is the most common pitfall in the cytodiagnosis of breast lesions. Of the cytological features described intracytoplasmic lumina are stressed by many authors as an important diagnostic feature. The present study aims at evaluating the importance of intracytoplasmic lumina in the cytodiagnosis of lobular carcinoma along with other cytological features. Fine needle aspirates from 11 cases of histologically proven classical lobular carcinomas of breast were reviewed. It was observed that the low cellularity, dispersed dyscohesive small cells, mild pleomorphism, nuclear moulding and Indian filing were the most important cytologic features which aid in the diagnosis of lobular carcinoma where as intracytoplasmic lumina were of little significance.

A Case of Gastric Metastasis of Breast Carcinoma Resembling Early Gastric Cancer / 대한소화기학회지

Many patients suffering from breast carcinoma have metastases at initial diagnosis. The common metastatic sites are skeleton, liver and lung. Metastases to stomach are rare and only three cases have been reported in Korea. The endoscopic features of gastric metastases from breast carcinoma can be divided into three main categories: diffuse infiltration, external compression, and localized tumor deposition with ulceration or with a polypoid mass. However, metastatic gastric lesions which resemble early gastric carcinoma are rare. Typically, gastric metastases are confined to submucosa and muscularis, so that mucosal biopsy specimens might be false-negative. We report a case of gastric metastasis from infiltrative lobular carcinoma of the breast in a 66-year-old woman who had undergone left mastectomy with postoperative radiotherapy 17 years earlier. Initial diagnosis was early gastric carcinoma, signet ring cell type on gastric biopsy findings. However, definitive diagnosis of metastatic breast cancer was confirmed after endoscopic mucosal resection of a presumed primary early gastric carcinoma.

Densidade mamográfica assimétrica: como investigar? (Revisão de literatura e apresentação de rotina de investigação) / Mammographic asymmetric density: how to investigate? (Literature review and proposal of investigation routine)

A distribuição de tecido fibroglandular nas mamas ocorre em sua maioria de forma simétrica, e qualquer alteração nesta simetria pode ser indício de lesão oculta no parênquima. A avaliação da densidade assimétrica constitui, portanto, um dos principais desafios no dia-a-dia do radiologista, no sentido de diferenciar áreas de superposição de estruturas normais de lesões parenquimatosas verdadeiras. O conhecimento das diferentes técnicas e dos recursos que podem ser utilizados na investigação das densidades assimétricas é de grande importância, assim como o estabelecimento de protocolo de sua avaliação, para que a origem dessas densidades seja plenamente estabelecida, uma vez que elas podem representar a única manifestação de um câncer de mama oculto, clínica e radiograficamente.

Granulocytic sarcoma of the breast preceding acute myelogenous leukemia: a case report

We report a case of granulocytic sarcoma presented as a recurrent breast tumor in a 42-year-old woman with no history of leukemia. The case was initially diagnosed as malignant lymphoma on a previous biopsy specimen and she refused chemotherapy. At the time of recurrence of the breast tumor, the patient showed full-blown features of leukemia. This case of rare tumor suggests that differential diagnosis should be considered when malignant lymphoma of the breast is detected.

Granulocytic sarcoma of the breast preceding acute myelogenous leukemia: a case report

We report a case of granulocytic sarcoma presented as a recurrent breast tumor in a 42-year-old woman with no history of leukemia. The case was initially diagnosed as malignant lymphoma on a previous biopsy specimen and she refused chemotherapy. At the time of recurrence of the breast tumor, the patient showed full-blown features of leukemia. This case of rare tumor suggests that differential diagnosis should be considered when malignant lymphoma of the breast is detected.

Metastasis de carcinoma de mama en ileon-colon y vesicula biliar simulando enfermedades inflamatórias / Breast carcinoma metastasis in ileum-colon and gallbladder simulating inflammatory diseases

Las metástasis en aparato digestivo, extrahepático son poco frecuentes y se caracterizan por presentarse luego de un período de latencia largo que va de 3 a 20 años, sus síntomas son inespecíficos y simulan enfermedades inflamatórias o segundo tumor. El subtipo histológico más común es el carcinoma lobulillar. Presentamos dos casos de metástasis de carcinoma de mama, uno en íleo-colon y otro en vesícula biliar. Ambas pacientes comenzaron con síntomas que llevaron a diagnósticos de enfermedad de Crohn en el primero y de colecistitis aguda en el caso dos. El diagnóstico se realizó en las piezas quirúrgicas, donde se observaron células de carcinoma lobulillar que infiltraban desde la serosa hasta la mucosa inclusive y con la inmunomarcación que resultaron BCA225, Estrógeno y Progesterona positivos. El tratamiento con radioterapia, quimioterapia u hormonal, mejora la calidad de vida, pero el promedio de sobrevida luego del diagnóstico es de un año.

Carcinoma lobulillar infiltrante: análisis de sus características radiológicas y ecográficas / Invasive lobular carcinoma

Analizamos las características de presentación clínica, radiológica y ecográfica de 52 casos de carcinoma lobulillar infiltrante (CLI), poniendo particular énfasis en el estudio de las características ecográficas. Los 52 casos, puros o combinados de CLI fueron confirmados por biopsia quirúrgica desde enero de 1991 a marzo de 1997. Todas las pacientes fueron estudiadas con examen clínico, mamografía y ecografía; en 25 casos se realizó punción citológica con agujas fina bajo control ecográfico, y en 3 punción histológica con guía estereotáctica digital. El examen clínico detectó anormalidades en 47 pacientes, cuyo rango varió de baja a alta sospecha. La mamografía detectó anormalidad focal en 44 casos. Las imágenes radiológicas se clasificaron en: negativas (n = 8), masas espiculadas (n = 15), masa de contornos poco definidos (n = 12), distorsión glandular (n = 7), asimetría (n = 4) y masa asociadad a microcalcificaciones (n = 6)

Carcinoma metastásico de mama en colon / Metastic carcinoma of breats and colon

Presentamos una forma poco habitual de la enfermedad metastásica de la mama, como son las lesiones encontradas en la esfera gastrointestinal y en especial, a nivel colorrectal. Se presentan dos casos clínicos que fueron estudiados e intervenidos en el servicio de colon y recto de la Universidad de Miami (Hospital Jackson Memorial), diagnosticados como carcinomas primarios de colon. Se ha descrito como causa más frecuentes de metástasis gastrointestinal al cáncer lobulillar. El objetivo es resaltar que con antecedentes de cáncer de mama y sintomatología gastrointestinal, debemos descartar entre los diagnósticos diferenciales a la enfermedad metastásica de la mama

Factores de pronóstico en cáncer de mama / Prognostic factors in breast cancer

El curso clínico del cáncer de mama puede ser muy diferente en los distintos individuos. Se realiza una revisión de los factores de pronóstico más estudiados y su utilidad para predecir la evolución de la enfermedad, ayudando así al clínico en la elección de la terapéutica más adecuada para prolongar la sobrevida libre de enfermedad y disminuir la mortalidad de estas pacientes. Se necesitan realizar estudios multicéntricos, a gran escala y a largo plazo para conocer la importancia relativa de cada uno de estos factores de pronóstico en la toma de decisiones.