Salivary gland tumor: atypical presentation of breast cancer

Breast cancer is a heterogeneous disease with various histological and molecular subtypes. Among them, salivary gland tumors are rare and can be divided into three groups: pure myoepithelial differentiation, pure epithelial differentiation and myoepithelial with mixed epithelial differentiation. In the last group, adenoid cystic carcinoma stands out, a rare entity with low malignant potential. It represents less than 0.1­3% of breast cancer cases and has the most frequent clinical presentation as a palpable mass. The diagnosis is confirmed by histology and immunohistochemistry. Classically, they are low-aggressive triple-negative tumors, with overall survival and specific cancer survival at five and ten years greater than 95%. However, there are rare reports of aggressive variants with a risk of distant metastasis and death. Treatment is based on surgical resection with margins. Lymphatic dissemination is rare, and there is no consensus regarding the indication of an axillary approach. Adjuvant radiotherapy is indicated in cases of conservative surgery and should be discussed in other cases. The benefit of chemotherapy remains uncertain, as most tumors are indolent. We report a case that required individualized decisions based on its peculiarities of presentation, diagnosed in an asymptomatic elderly patient during screening, in which mammography showed heterogeneous gross calcifications clustered covering 1.6 cm. Stereotacticguided vacuum-assisted biopsy was performed, and the area was marked with a clip. The anatomopathological examination led to a diagnosis of salivary gland-type carcinoma, triple-negative. The patient underwent segmental resection of the right breast and sentinel lymph node biopsy. The final anatomopathological result was similar to that of the biopsy, with an immunohistochemicalprofile of the adenoid cystic type and two sentinel lymph nodes free of neoplasia. Considering age and histological subtype, adjuvant therapy was not indicated. Follow-up for three years showed no evidence of disease

Prognostic factors in triple-negative breast cancer: a retrospective cohort

SUMMARY OBJECTIVE: Triple-negative breast cancer (TNBC) is characterized by lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expression and accounts for 15-20% of all breast cancers. This study aims to analyze prognostic factors related to a reduction in overall survival (OS), disease-free survival (DFS), and risk of mortality and recurrence in TNBC. METHODS: This is a retrospective observational cohort study. Medical records of 532 patients with breast cancer diagnosed from 2007 to 2020 were analyzed. Of these patients, 93 (17%) were women with TNBC. Ten medical records were excluded, and the final sample was composed of 83 women with TNBC. OS and DFS were estimated by the Kaplan-Meier model. Univariate analysis (log-rank test) and multivariate analysis (Cox regression) were used to examine prognostic factors related to a statistically significant reduction (p<0.05) in OS and DFS and increased risk of mortality and tumor recurrence. RESULTS: Smoking, advanced clinical stage, larger tumor size, angiolymphatic invasion, positive sentinel lymph node, axillary node involvement, higher cancer burden, surgical treatment with mastectomy, and recurrence were related to a significant decrease in OS and/or DFS and increased risk of mortality and/or recurrence in TNBC. The 10-year OS and DFS was around 61 and 65%, respectively. CONCLUSIONS: Advanced clinical stage, positive sentinel lymph node, axillary node involvement, surgical treatment with mastectomy, and higher residual cancer burden were related to a significant reduction in OS and DFS and increased risk of mortality and recurrence in TNBC.

aggressive triple negative breast cancer with early but favorable brain metastatic course

Breast cancer is the second most common cause pf brain metastasis. Although patient prognosis is poor, isolated brain metastasis occasionally can be an option for treatment with curative intent in breast cancer patients. We report a patient with invasive ductal carcinoma of the breast who developed an isolated right frontal lobe metastasis within 5 months of finishing her breast cancer treatment. Despite aggressive course of primary disease the metastasis was successfully controlled by surgical excision and adjuvant whole brain radiation therapy. The patient is now quiet well and disease free approximately six years after treatment of brain metastasis. A small subgroup of brain metastasis with breast primary can have a considerable survival with adequate local treatment