Clinical Features of the Male Breast Cancer-13 Cases / 한국유방암학회지

Purpose: Breast cancer is one of the most frequent malignant tumors in American and European countries, with incidences increasing every year. In Korea it was the second most frequent cancer in 2002, followed by stomach cancer. However, in 2001 the incidence of breast cancer was first, followed by colon cancer, with incidences increasing every year. Conversely, breast cancer in men is not frequent, with an incidence of less than 1%, according to studies from both Korea and abroad. Studies on the treatment methods and prognostic factors of breast cancer in men are limited, with little clinical experience. Although there was difficulty in collecting complete data, due to lack of awareness of male breast cancer, the clinical characteristics could be determined from the experience and treatment outcomes of male breast cancer patients. Methods: The medical records of 13 male patients with breast cancer, who could be followed up, were retrospectively evaluated from 4809 patients with breast cancer, evaluated between 1989 and 2003. Results: The average age of the subjects was 64.3 years, with the breast masses with no pain situated at the center of the breast in most cases. The affected period in most patients was 1 year, with most having stage II breast cancer. Conclusion: Although asymptomatic unilateral subareolar breast mass in old ages is the most frequent symptom, most missed the period for early treatment due to lack of awareness of male breast cancer, therefore, their breast cancer had been for more than a year. Despite the difficulty due to the lack of data, attention needs to paid, and continuous studies required, toward male breast cancer.

External Anatomic Localization of Sentinel Lymph Nodes in Breast Cancer: Relationship with Axillary Hair Line and Pectoralis Major Muscle / 한국유방암학회지

PURPOSE: Recent studies have shown that the false negative rate of sentinel lymph node (SLN) biopsy is less than 5% and SLN biopsy is accepted as a highly accurate method for evaluating axillary lymph node metastasis in breast cancer. Purpose of this study was to evaluate the relationship between the location of SLNs and external anatomical structures of axilla in order to help a proper skin incision. METHODS: Between July 2001 and May 2002, SLN biopsies were performed in 25 breast cancer patients. SLNs were detected by hand-held gamma probe after subareolar injections of 99m-Tc antimony sulfur colloid. The location of the SLNs was indicated in terms of distance and direction from the lateral border of pectoralis major muscle and the axillary hair line. Breast conserving surgery or mastectomy was performed with axillary dissection in all cases. RESULTS: The location of tumors was the upper outer quadrant in 11 cases; the central portion in 4 cases; the upper inner quadrant in 4 cases; the lower inner quadrant in 3 cases; and the lower outer quadrant in 3 cases. Lymph nodemetastases were found in 5 cases of which SLNs were only metastatic nodes in 2 cases. The mean number of SLNs was 1.6. The false negative rate of SLN biopsy was 4.0% (1/25), giving a diagnostic accuracy of 96.0% (24/25). All the SLNs were located between the lateral border of pectoralis major muscle and the axillary hair line and the distance from the inferior tip of the hair line was as follows: 2 cases within 0.5 cm; 3 cases between 0.6 cm and 1 cm; 14 cases between 1.1 cm and 1.5 cm; 2 cases between 1.6 cm and 2.0 cm; 3 cases between 2.1 cm and 2.5 cm; 1 case between 2.6 cm and 3.0 cm. All the SLNs were located within a 3 cm diameter circle between the axillary hair line and the lateral border of pectoralis major muscle. CONCLUSION: The SLNs in breast cancer are located in a small area between the lateral border of pectoralis major muscle and the axillary hair line.

Congenital Diaphragmatic Hernia in Rats Using Nitrofen: An Animal Model

PURPOSE: Since 1971, Nitrofen (2,4-dichloro-4`-nitrodiphenyl ether) herbicide has been known to induce variable congenital abnormalities in rats. However, until now there has been no animal model of congenital diaphragmatic hernia (CDH) using this herbicide in Korea. Therefore, CDH in rats using Nitrofen was tried for searching on pathogenesis or using therapeutic modalities of CDH. METHODS: 20 Sprague-Dawley rats ingested Nitrofen as indicated on the 9.5th day of gestation, and after sacrificing on the 21th day of gestation. 243 offspring were harvested for the examination of diaphragmatic herniations. Dissections were made along sites of herniations to confirm the diaphragmatic herniation's site and size, lung/body weight ratio comparison as well as to accomplish microscopic radial saccular counting and evaluation of alveolar septal wall maturations and a comparision was made between the groups. RESULTS: CDH appeared in 149 of 243 offspring. CDH only appeared in the posterior portion of the diaphragm regardless of size or the side of appearance. Left sided CDH was the most common single diaphragmatic anomaly, represented in 112 offspring. Right sided CDH was next, found in 31 offspring, and bilateral CDH was seen in 6 offspring. Left sided CDH was almost always associated with visceral herniations and with pulmonary hypoplasia on the affected side, which was proved in the decreased Lung/Body weight ratio and in decreased radial saccular counts and in increased alveolar septal wall thickness in the affected lungs of CDH. In94 offspring without CDH following exposure to Nitrofen, moderate pulmonary hypo plasia was microscopically observed. CONCLUSION: Initial Rat modeling of congenital diaphragmatic hernia using Nitrofen showed results of herniation and pulmonary hypoplasia of the affected lungs acceptable for further experimental studies on CDH and accompaning pulmonary abnormalities.

Clinical Characteristics and Recurrence Patterns of Malignant Phyllodes Tumors

PURPOSE: Malignant phyllodes tumors are rare lesions of the breast. The purpose of this study was to evaluate the clinical charateristics and the recurrence patterns of malignant phyllodes tumors. METHODS: Twelve patients with malignant phyllodes tumors who had undergone surgery at the Breast Clinic, Asan Medical Center, from February 1991 to October 1997 were analyzed retrospectively. Histologic criteria of malignant phyllodes tumor was more than 10 mitoses/10 high-power fields in this study. RESULTS: The mean age of the patients was 40.7 years. As regards to preoperative histological confirmation, malignant phyllodes tumors were proven in all 6 cases with an excision biopsy, but in only one of the 4 cases with fine needle aspiration. All the patients received surgical treatment: a modified radical mas tectomy in 4 cases, a simple mastectomy in 5 cases, a simple mastectomy with reconstruction in 2 cases, and a subcutaneous mastectomy in one case. During 34 months of mean follow-up, 3 patients had a recurrence. One patient had a chest wall recurrence at 29 months and lung metastasis at 48 months; the others had lung metastasis at 14 and 16 months, respectively. CONCLUSION: Malignant phyllodes tumors were difficult to confirm with fine needle aspiration preoperatively. The lung was the main site of metastasis, and if metastasis occurred, the prognosis was very poor.

Breast Cancer during Pregnancy and Lactation

BACKGROUND: The clinical features of breast cancer associated with pregnancy and lactation remain unknown in many aspects, partly because the incidence is relatively low. The purpose of this study was to evaluate clinicopathologic characteristics and the survival rate of pregnancy-associated breast cancer patients. METHODS: Among 1,265 breast cancer patients treated at the Breast Clinic of Asan Medical Center from July 1989 to December 1998, 13 subjects with breast cancer diagnosed during pregnancy (2 cases) and lactation (11 cases) were evaluated retrospectively. RESULTS: The incidence of pregnancy-associated breast cancer was 1.03% of all breast cancer patients. The mean age and the symptom duration of the subjects was 31.2 years and 8.8 months, repectively. As for surgical procedure, a modified radical mastectomy and breast-conserving surgery were carried out in 10 cases (76.9%) and 2 cases (15.4%), respectively. The median tumor size was 4.0 cm. Lymph node metastases were found in 7 cases (61.5%). According to the TNM classification, all of the patients showed stage II or above tumors. Invasive ductal carcinoma (10 cases, 76.9%) was the most common histopathologic type of tumor. The positive rate of ER and PR in the subjects were 63.6% and 50.0%, respectively. The 3-year overall survival rate and disease-free survival rate were 69.9% and 44.4%, respectively. CONCLUSIONS: This study shows that most of the patients with breast cancer during pregnancy and lactation are in a more advanced stage with a delay in detection and diagnosis, and hence have a unfavorable prognosis.

Skin Sparing Mastectomy with Circumareolar Incision and Immediate TRAM and One-Stage Star Flap Nipple-Areolar Complex Reconstruction / 한국유방암학회지

BACKGROUND: Breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar formation on the breast skin after reconstruction. A skin-sparing mastectomy (SSM) with one-stage star flap nipple-areolar complex immediate reconstruction makes minimal scar tissue, and with a circumferential incision is made around the nipple, becoming virtually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of thins method for the indicated patients. MATERIALS AND METHODS: During the recent 3 years, 1996 through 1999, there were 1027 breast-cancer surgeries. Among them, there were 61 reconstruction cases, a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 patients were taken SSM and TRAM flap reconstruction. Our patients selection criteria of SSM was as follows, diffuse DCIS that not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex. RESULTS: All the surgeries performed under these procedures were considered to be successful. All of the TRAM flap and star flap were alive. The main rawback was bleeding, which occurred in 6 patients but was managed by transfusion. The wound seroma occurred in 3 patients and was managed easily by repeated aspiration. CONCLUSIONS: Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied. We propose more frequent application of this method for the indicated patients, but we need further follow-up of the local recurrence rate and the detection rate in these patients.