Report on a case of pure cribriform carcinoma of the breast with internal mammary node metastasis: description of the case and review of the literature.

AIMS AND BACKGROUND: Pure ductal invasive carcinoma of the breast is more frequently associated with lymphatic invasion, lymph node involvement and high malignant histological grade than combined forms of breast carcinoma. Internal mammary node metastases are not frequently detected when the axillary nodes are negative. PATIENTS AND METHODS: We report our experience of a case of pure cribriform carcinoma, associated with an intraductal cribriform component, in which the sentinel axillary nodes were negative, while nodal and perinodal metastasis was detected in one internal mammary lymph node. CONCLUSIONS: Data from the literature show that positive internal mammary nodes are an unusual finding when the axillary sentinel node is negative, especially in cases of cancer with a relatively good prognosis, such as cribriform cases.

Urinary bladder metastases from breast carcinoma: review of the literature starting from a clinical case.

Bladder metastases from solid tumors are rare. Breast carcinoma cells seldom spread to the urinary bladder. We report the case of a patient with invasive breast carcinoma who developed a breast recurrence followed by bone and urinary bladder metastases. Starting from this clinical case we review the available literature on this issue. Only few cases of urinary bladder metastases from primary breast cancer have been reported, although the case reports have increased in recent years. Patients with breast cancer presenting with urinary symptoms should be examined for possible bladder metastases.

Sentinel node biopsy in breast cancer: early results in 953 patients with negative sentinel node biopsy and no axillary dissection.

Sentinel node biopsy in patients with breast carcinoma accurately predicts the axillary nodal status. However, in some 6% of patients with negative sentinel nodes the remaining axillary nodes harbour metastases. Our purpose was to observe a large number of patients who did not undergo an axillary dissection after a negative sentinel node biopsy for the appearance of overt axillary metastases. 953 patients treated from 1996 to 2000, with negative sentinel nodes not submitted to axillary dissection, were followed-up to 7 years, with a median follow-up of 38 months. Fifty-five unfavourable events occurred among the 953 patients, 37 (4%) related to the primary breast carcinoma. Three cases of overt axillary metastases were found: they received total axillary dissection and are presently alive and well. The 5 year overall survival rate of the whole series was 98%. Patients with negative sentinel node biopsies not submitted to axillary dissection show during follow-up a rate of overt axillary metastases that is lower than that expected.

Intraoperative radiotherapy during breast conserving surgery in patients previously treated with radiotherapy for Hodgkin's disease.

AIMS AND BACKGROUND: Women who have received radiotherapy for Hodgkin's disease have an increased risk of developing breast cancer. Breast-conserving surgery followed by breast irradiation is generally considered to be contraindicated in such patients owing to the high cumulative radiation dose to the breast. Mastectomy is therefore recommended as the preferred treatment option in these women. METHODS: We report 3 patients affected by breast cancer who had previously been treated with mantle radiation for Hodgkin's disease and on whom breast-conserving surgery and full-dose intraoperative radiotherapy with electrons (ELIOT) were performed. RESULTS: A total dose of 17 Gy (prescribed at 100% isodose) in one case and 21 Gy (at the 90% isodose) in two cases was delivered directly to the mammary gland without acute complications and with good cosmetic results. CONCLUSIONS: In women previously irradiated for Hodgkin's disease, ELIOT could avoid repeat irradiation of the whole breast, thereby permitting conservative surgical treatment.

Sentinel lymph node metastasis in microinvasive breast cancer.

BACKGROUND: Ductal carcinoma in situ with microinvasion (DCISM) is a separate pathological entity, distinct from pure ductal carcinoma in situ (DCIS). DCISM is a true invasive breast carcinoma with a well-known metastatic potential. Currently, there is controversy regarding the indication for complete axillary dissection (CAD) to stage the axilla in patients with DCISM. The role of CAD is questioned given its morbidity and reported low incidence of axillary involvement. Sentinel lymph node biopsy (SLNB) may obviate the need for CAD in these patients without compromising the staging of the axilla and the important prognostic information. METHODS: From March 1996 to December 2002, 4602 consecutive patients with invasive breast carcinoma underwent SLN biopsy. Of these, 41 patients with DCISM were selected. RESULTS: Metastasis in the SLN were detected in 4 of 41 (9.7%) patients. Two of the 4 patients had only micrometastasis in the SLN. In three patients, the SLN was the only positive node after CAD. CONCLUSIONS: SLN biopsy should be considered as a standard procedure in DCISM patients. SLNB can detect nodal micrometastasis and accurately stage the axilla avoiding the morbidity of a CAD. Complete AD may not be mandatory if only the SLN contains micrometastatic disease. Informed consent is very important in the decision not to undergo CAD.