Carcinoid tumor of the breast: treatment with breast conservation in three patients.

BACKGROUND: Carcinoid tumors of the breast have been described in the literature. The diagnosis is made by identification of typical histologic features and confirmed by a positive argyrophilic reaction or the presence of neurosecretory granules. There are several theories of the pathogenesis of carcinoid tumors in the breast and controversy as to whether these tumors actually originate in the breast ducts or are tumors that arise from neuroectodermal cells that have migrated to the breast ducts. Historically, treatment of carcinoid of the breast has been by mastectomy. METHODS: We report three cases of primary carcinoid tumor of the breast treated with lumpectomy and axillary node dissection. No adjuvant radiation or systemic treatment was administered. RESULTS: In all three cases, no metastases were identified in lymph nodes sampled and all patients have remained clinically free of recurrent disease. CONCLUSIONS: Decisions about the need for radiation or systemic treatment of breast carcinoid tumors depend on one's interpretation of the pathogenesis of this disease. Breast conservation is a surgical option that has not been previously reported. Larger series of carcinoid tumors of the breast, their treatment, and their follow-up are needed.

Photodynamic therapy in the management of metastatic cutaneous adenocarcinomas: case reports from phase 1/2 studies using tin ethyl etiopurpurin (SnET2).

BACKGROUND AND OBJECTIVES: Photodynamic therapy (PDT) using a photoreactive purpurin, tin ethyl etiopurpurin (SnET2, Purlytin, Miravant Medical Technologies, Santa Barbara, CA), was investigated as a treatment for cutaneous metastatic disease that had failed other treatment options. STUDY DESIGN/MATERIALS AND METHODS: Three patients with biopsy-proven metastatic adenocarcinoma of the skin were treated with a single dose of the study drug. Twenty-four hours later, the patients were exposed to a laser light at 664 nm in multiple light fields. Patients were followed for 6 months for safety, efficacy, recurrence, and palliative response. RESULTS: After PDT with SnET2, complete response was observed in all 13 treated lesions in three patients, with no evidence of recurrence at any treated site at the 6-month follow-up. Two patients subsequently died of distant metastatic disease. One patient with local chest wall recurrence after mastectomy was disease-free 24 months after PDT. CONCLUSIONS: PDT with SnET2 could be an effective treatment in locally advanced metastatic carcinoma of the skin.

Palpable abnormalities of the breast not requiring excisional biopsy.

The evaluation of a patient with a palpable abnormality of the breast typically includes physical examination, mammography and fine needle aspiration biopsy (FNAB) with cytologic interpretation of the aspirate. If the findings of these three diagnostic modalities are negative for malignancy, the current standard of care is to proceed to surgical biopsy to confirm the benign nature of the lesion. The current study was done to identify a subset of patients who could be safely observed without surgical (histologic) biopsy. These patients fulfilled specified criteria on physical examination, mammogram and needle sensation when the FNAB needle entered the lesion. Results of the cytologic studies of the FNAB were used as a corroborative rather than as a diagnostic test. Of 305 patients with mammary abnormalities, 106 were identified with "subsuspicious" lesions. Seven of the latter patients underwent surgical biopsy, four because the results of cytologic studies of FNAB revealed cytologic atypia. One of the four patients had infiltrating ductal carcinoma. All other patients have had follow-up evaluation for a mean of 61 months (range of 43 to 74 months). No carcinomas have developed at the subsuspicious site. The current study is the first to clearly define a subset of patients with palpable abnormalities of the breast who do not require surgical biopsy.

The use of closed suction drainage after lumpectomy and axillary node dissection for breast cancer. A prospective randomized trial.

Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a drain group (DG) and 119 to a no drain group (NDG). Drains were removed on the first postoperative day just before patient discharge. Postoperatively, all palpable axillary collections were aspirated on each follow-up visit. The volume aspirated, the number of aspirations, the time to seroma resolution, and all complications were recorded. The mean number of aspirations in the DG was significantly lower than the NDG (2.2 +/- 2.2 versus 3.3 +/- 2.1; p less than or equal to 0.002). Mean volume aspirated in the DG (146.3 +/- 181.1 mL) was less than the NDG (266.1 +/- 247.6 mL; p less than or equal to 0.003), and the time to seroma resolution was decreased in the DG as compared with the NDG (11.5 +/- 10 days versus 18 +/- 10.1 days; p less than or equal to 0.0002). Closed suction drainage after lumpectomy and axillary node dissection is advantageous in decreasing the incidence and degree of seroma formation and need not delay early hospital discharge.

Experience with a modified fine-needle aspiration biopsy technique in 533 breast cases.

Aspiration cytology depends on skillful preparation of smears, which normally requires a trained cytotechnologist. Collection of aspirates into Saccomanno fixative permits preparation of high-quality smears by trained technologists no matter who does the aspiration. Aspiration by a surgeon was used with palpation and mammography to examine 533 patients in an office-based regional breast health program. Lesions sampled ranged from diffuse thickening to frank tumors. Lesions suspicious to any one of the three examinations were biopsed. Cytologically diagnosable material was obtained in 349 instances: 120 were malignant, 22 suspicious, 12 atypical, and 195 benign. Of the 184 yielding insufficient cells, 116 were benign on palpation and mammography, and 68 were suspicious. Biopsy proved 57 of these benign and 11 malignant. There were no cytologic false positives in the study. There was a 2% false-negative rate on productive aspirates. Nonproductive aspiration occurred in 4.8% of malignant cases.

Use of pectoralis minor muscle in immediate reconstruction of the breast.

A technique is described in which the pectoralis minor muscle is rotated as a muscle pedicle flap to be used in immediate reconstruction of the breast. The advantages of this procedure are that it provides additional muscle coverage over the prosthesis as well as preventing lateral displacement. Seven patients have undergone this technique with excellent results.

Fine-needle aspiration biopsy in the management of solid breast tumors.

Fine-needle aspiration biopsy (FNA) is a cost-effective and clinically reliable tool in the management of palpable solid breast lesions. Review of 369 FNA biopsy specimens revealed an accuracy of 92%. The sensitivity was 78% and the specificity was 100%. There were no false-positive results. Positive predictive value was 100%, and negative predictive value was 78%. A positive FNA biopsy result, which confirms a clinical (physical examination and mammography) impression of carcinoma, can be the basis for planning and performing a definitive procedure. Despite the absence of false-positive results, we have not proceeded with a definitive surgical procedure if an FNA biopsy result disagreed with our clinical impression. Fine-needle aspiration biopsy may be used to reassure and support both the patient's and the surgeon's decision not to perform a biopsy of "subsuspicious lesions." A negative FNA biopsy result does not exonerate the clinically suspicious lesion.