[Magnetic resonance imaging in preoperative diagnosis of invasive lobular carcinomas of the breast - analysis of 230 cases]. / Magnetická rezonance v predoperacní diagnostice invazivních lobulárních karcinomu prsu - analýza 230 prípadu.

INTRODUCTION: In breast cancer patients, magnetic resonance imaging (MRI) is a supportive method characterized by high sensitivity. Its indications in the preoperative assessment are not clearly defined. More likely to benefit from preoperative MRI are younger women, women with a dense breast on mammography and patients with invasive lobular carcinoma (ILC). The aim of this study was to assess utilization of MRI and resulting benefits in preoperative tumour staging of ILC in patients treated in our institution. METHODS: A retrospective evaluation of medical records of all patients with bioptically proven and primarily surgically treated ILC through the years 20142016. RESULTS: Overall, 230 patients were evaluated, among them 131 (57.0%) underwent MRI. These patients were significantly younger than patients without MRI. The results of MRI were as follows: in 28.2% a small unicentric lesion, in 41.2% large infiltration or multifocality, and in 30.5% suspicion of multicentricity. The proportion of conservative surgeries and re-resections did not differ between the patients with and without MRI. The subgroup of patients with a small unicentric lesion on MRI showed a higher proportion of conservative surgeries and fewer re-resections compared to the other subgroups. In 41 women (31.3%) the MRI finding resulted in further assessments; in 29 (22.1%) an additional biopsy was done, with a malignant result in the ipsilateral breast in 8 cases and in the contralateral breast in 3 cases. The MRI finding had a substantial impact on surgery in 35 patients (26.7%) of whom it was evaluated as clinically beneficial in 23 (65.7%) cases. CONCLUSION: At our institution, more than a half of patients with ILC undergo MRI preoperatively. The finding has an impact on the scope of the surgery in approximately one fourth of the cases, being clinically beneficial in most of them. However, a high frequency of additional imaging assessments and biopsies should be taken into account. Due to the low specificity of MRI, every suspicious lesion has to be bioptically verified to avoid inappropriate surgery and patient harm.Key words: breast cancer - invasive lobular carcinoma - magnetic resonance imaging - occult lesion - biopsy.

[Carney triad]. / Carneyho trias.

Carney triad is a synchronous or metachronous association of gastric gastrointestinal stromal tumors (GIST), pulmonary chondroma and extra-adrenal paraganglioma. The majority of patients have only one or two components of the triad, all three tumors being found in only about 2% of the patients at the time of the first diagnosis. The most common combination is gastric and pulmonary tumors. We report a case of Carney triad which was diagnosed at Masaryk Memorial Cancer Institute. A 57-year-old female patient with a history of gastric resection for leiomyosarcoma at the age of 14 and with an unclear pulmonary lesion evident on chest X-ray since as early as 2003. She was referred to our Clinic of Comprehensive Cancer Care after being diagnosed with unspecified tumors of the stomach, the left retroperitoneum and two liver metastases. Biopsy of the retroperitoneal mass was performed and histological examination showed pheochromocytoma. The patient underwent resection of the retroperitoneal tumor and wedge resection of the gastric tumor, left hemihepatectomy and left adrenalectomy (in two separate operations). The excised gastric tumor was a gastrointestinal stromal tumor (GIST) with a low risk of malignancy. Analysis of a liver specimen, however, showed two GIST metastases. No pathology was found in the left adrenal gland and the retroperitoneal tumor was positive for chromogranin A. Paraganglioma was thus diagnosed. Subsequently, mutational analysis of genes coding for succinate dehydrogenase subunits B, C and D (SDHB, SDHC, SDHD) and analysis of DNA methylation at the gene locus of SDHC was made. Carney triad was thus confirmed and the unclear pulmonary lesion could be described as benign chondroma. This report demonstrates the difficulty in distinguishing between Carney triad and Carney-Stratakis syndrome. Molecular information should improve the diagnosis of Carney triad.Key words: Carney triad - GIST pulmonary chondroma extraadrenal paragangliomaCarney-Stratakis syndrome.