Fibromatosis-like metaplastic carcinoma of the breast:Two case reports

BACKGROUND Fibromatosis-like metaplastic carcinoma is classified as a rare type of metaplastic carcinoma of the breast by the 2012 WHO pathological and genetic classification criteria for breast tumors,which takes hyperplastic spindle cells as the main component and is often misdiagnosed as benign stromal proliferative lesions or benign mesenchymal tumors of the breast because of its mild morphology.Here,we collected the clinical data of 2 cases of fibromatosis-like metaplastic carcinoma of the breast and performed pathomorphological observation and immunohistochemical staining of the surgically resected specimens.According to the clinical features,imaging features,immunophenotype,diagnosis and differential diagnosis of 2 cases of fibromatosis-like metaplastic carcinoma of the breast,it was further differentiated.CASE SUMMARY Case 1:A 56-year-old postmenopausal female was admitted due to"right breast mass for over 1 year and local ulceration for over 1 mo".Physical examination showed a mass with a diameter of 4.5 cm×5.5 cm palpable at 2.5 cm from the nipple at 1 o'clock in the right breast.The skin on the surface of the mass ruptured about 3 cm,with a small amount of exudation and bleeding,less clear boundary,hard texture,fair activity,without obvious tenderness.No obvious abnormality was palpable in the left breast.No enlarged lymph nodes were palpable in the bilateral axillae and bilateral supraclavicular region.After removing the mass tissue,it was promptly sent to the pathology department for examination.Case 2:Female,52-years-old,premenopausal,admitted due to"right breast mass for more than 3 mo".Physical examination showed a 4.0 cm×4.0 cm diameter mass palpable at 2.0 cm of the nipple in the lower outer 7 o'clock direction of the right breast,with less clear boundary,hard texture,fair activity,no significant tenderness,no palpable significant abnormalities in the left breast,and no palpable enlarged lymph nodes in the bilateral axillae and bilateral supraclavicular region.The mass was resected and sent for pathological examination.Postoperative pathological examination revealed fibromatosis-like metaplastic carcinoma of the breast in both patient 1 and patient 2.No systemic therapy and local radiotherapy were performed after surgery,and no tumor recurrence or metastasis was observed.CONCLUSION Fibromatosis-like metaplastic carcinoma of the breast is a rare subtype of metaplastic carcinoma that is often misdiagnosed,and the diagnosis relies on medical history collection,complete sampling,and full use of immunohistochemical assessment.The risk of lymph node and distant metastasis is low,and the current treatment is based on complete surgical resection.The efficacy of systemic radiotherapy and chemotherapy is not clear.

Primary acinic cell carcinoma of the breast: A case report and review of literature

BACKGROUND In the current World Health Organization classification,acinic cell carcinoma(AcCC)of the breast is considered a rare histological subtype of triple-negative breast cancer.Because of the few reports in the literature,data concerning clinical outcomes are limited.Here,we report a case of AcCC of the breast in a 48-year-old woman.A 48-year-old woman with a mass in her right breast came to our hospital for further diagnosis.Mammography and an ultrasound(US)scan showed a mass in the upper inner side of the right breast.She then underwent surgery to resect the mass in her right breast.Postoperative pathological examination revealed that the tumor had abundant acinar-like structures formed by tumor cells with prominent eosinophilic granules in the cytoplasm,consistent with acinar cell carcinoma.The results of immunohistochemical analysis supported the diagnosis of breast acinar cell carcinoma.Two months later,she underwent breast-conserving surgery and sentinel lymph node biopsy.The pTNM stage was T2N0M0.After surgery,the patient received 30 radiotherapy sessions.The patient was followed up for a period of one year,and no recurrence was found.AcCC of the breast is a rare type of malignant tumor.Because it is usually asym-ptomatic and can be detected by imaging studies,routine breast US or mamm-ograms are important.However,there are no characteristic diagnostic imaging findings or clinical manifestations,so immunohistochemical examination is critical for an accurate diagnosis of AcCC of the breast.

Polo-like kinase 1 as a biomarker predicts the prognosis and immunotherapy of breast invasive carcinoma patients

Invasive breast carcinoma(BRCA)is associated with poor prognosis and high risk of mortality.Therefore,it is critical to identify novel biomarkers for the prognostic assessment of BRCA.Methods:The expression data of polo-like kinase 1(PLK1)in BRCA and the corresponding clinical information were extracted from TCGA and GEO databases.PLK1 expression was validated in diverse breast cancer cell lines by quantitative real-time polymerase chain reaction(qRT-PCR)and western blotting.Single sample gene set enrichment analysis(ssGSEA)was performed to evaluate immune infiltration in the BRCA microenvironment,and the random forest(RF)and support vector machine(SVM)algorithms were used to screen for the hub infiltrating cells and calculate the immunophenoscore(IPS).The RF algorithm and COX regression model were applied to calculate survival risk scores based on the PLK1 expression and immune cell infiltration.Finally,a prognostic nomogram was constructed with the risk score and pathological stage,and its clinical potential was evaluated by plotting calibration charts and DCA curves.The application of the nomogram was further validated in an immunotherapy cohort.Results:PLK1 expression was significantly higher in the tumor samples in TCGA-BRCA cohort.Furthermore,PLK1 expression level,age and stage were identified as independent prognostic factors of BRCA.While the IPS was unaffected by PLK1 expression,the TMB and MATH scores were higher in the PLK1-high group,and the TIDE scores were higher for the PLK1-low patients.We also identified 6 immune cell types with high infiltration,along with 11 immune cell types with low infiltration in the PLK1-high tumors.A risk score was devised using PLK1 expression and hub immune cells,which predicted the prognosis of BRCA patients.In addition,a nomogram was constructed based on the risk score and pathological staging,and showed good predictive performance.Conclusions:PLK1 expression and immune cell infiltration can predict post-immunotherapy prognosis of BRCA patients.

Invasive breast carcinoma with osteoclast-like stromal giant cells:A case report

BACKGROUND Invasive breast carcinoma with osteoclast-like stromal giant cells(OGCs) is an extremely rare morphology of breast carcinomas.To the best of our knowledge,the most recent case report describing this rare pathology was published six years ago.The mechanism controlling the development of this unique histological formation is still unknown.Further,the prognosis of patients with OGC involvement is also controversial.CASE SUMMARY We report the case of a 48-year-old woman,who presented to the outpatient department with a palpable,growing,painless mass in her left breast for about one year.Sonography and mammography revealed a 26.5 mm ×18.8 mm asymmetric,lobular mass with circumscribed margin and the Breast Imaging Reporting and Data System was category 4C.Sono-guided aspiration biopsy revealed invasive ductal carcinoma.The patient underwent breast conserving surgery and was diagnosed with invasive breast carcinoma with OGCs,grade Ⅱ,with intermediate grade of ductal carcinoma in situ(ER:80%,3+,PR:80%,3+,HER-2:negative,Ki 67:30%).Adjuvant chemotherapy and post-operation radiotherapy were initiated thereafter.CONCLUSION As a rare morphology of breast cancer,breast carcinoma with OGC occurs most often in relatively young women,has less lymph node involvement,and its occurrence is not racedependent.

Nasopharyngeal carcinoma with synchronous breast metastasis:A case report

BACKGROUND Recent reports have described cases of metachronous breast metastasis in patients with nasopharyngeal carcinoma.However,no similar cases of synchronous breast metastasis have been reported,and evidence that can be used to support the clinical diagnosis of stage IV nasopharyngeal carcinoma in patients with concurrent breast metastasis remains lacking.Therefore,additional evidence is required to elucidate the clinical characteristics of this condition and aid in the development of optimal management strategies.CASE SUMMARY We report the case of a 46-year-old woman who visited our hospital with a right breast mass as the first symptom.The first pathological biopsy report suggested triple-negative breast invasive carcinoma.Subsequent imaging revealed a nasopharyngeal mass.Further puncture biopsy of the nasopharyngeal mass,molecular pathological Epstein–Barr virus in situ hybridization,and immunohistochemistry confirmed the diagnosis of nasopharyngeal carcinoma with breast metastasis.The patient did not undergo a mastectomy and achieved complete remission after chemotherapy and radiotherapy.She continued to receive oral chemotherapy as maintenance therapy and experienced no recurrence or metastasis during the 6-month follow-up period.CONCLUSION This case report suggests that breast specialists should carefully rule out secondary breast cancers when diagnosing and treating breast masses.Furthermore,clinicians should aim to identify the pathological type of the tumor to obtain the most accurate diagnosis and prevent excessive diagnosis and treatment.

Metaplastic Carcinoma of the Breast: A Clinical Study of 7 Cases from Balochistan

Metaplastic carcinomas of the breast are rare heterogenous neoplasms characterized by adenocarcinoma with dominant areas of spindle cells, squamous and/or other mesenchymal differentiation, that comprise of <5% of all invasive breast cancers. Our objective in this study was to review the pathological features and clinical outcomes for metaplastic carcinoma of breast in breast cancer patients registered in CENAR (Center for Nuclear Medicines and Radiotherapy), Balochistan. Present study was performed on 7 patients affected with metaplastic carcinoma of breast, who were registered patients in CENAR. Informed consent was taken from the patients and BMI was calculated by measuring the height and weight of the patients. Available clinical history obtained by retrieving the patients file and a copy of biopsy report was also obtained from the file. Metaplastic carcinoma of breast was 4.11% of all 170 breast cancer cases registered in CENAR from 2010-2012. Mean age was 40 years ranging from 25 - 50 years. Four subtypes of metaplastic carcinoma of breast were reported in this study;DCIS component was present in one case and mean tumor size was 6.12 cm ranging from 3.5 - 10 cm. Metaplastic carcinomas of breast are rare heterogenous neoplasm with different characteristics, demographics and tumor biology and accounts for almost >5% of all breast cancer cases.

Clinic pathological features and prognosis of metaplastic breast carcinoma

Objective:To investigate clinic pathological peculiarities and evaluate the prognosis of metaplastic breast carcinoma.Methods:Patients with metaplastic breast carcinoma at the First Affiliated Hospital of Zhejiang University and Guangxing Hospital Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from 2008 to 2013 were retrospectively selected.Results:A total of 73 female patients were reviewed,including 41 cases of purely epithelial type and 32 cases of mixed epithelial and mesenchymal type.Median tumor size was 4.6cm.Forty-three patients(58.8%)presented with lymph node metastasis,84.9%of cases were in advanced TNM stage,and 60.2%of cases were overexpressed by Ki-67.At a median follow-up of 59 months,median overall survival and disease-free survival were 59.7 and 43.9 months,respectively.Five-year overall survival rate was 45.2%and disease-free survival rate was 30.1%,and 76.7%of patients had recurrence or metastasis.Univariate analysis showed that tumor size,lymph node,and radiotherapy were associated with overall survival and disease-free survival(P<0.05),while Ki-67 over-expression was correlated with overall survival(P<0.05).With multivariate analysis,tumor size,lymph node,and radiotherapy affected prognosis(P<0.05);however,pathological typing was not an independent prognostic factor(P>0.05).Conclusion:Metaplastic breast carcinoma is a rare malignant tumor with large tumor,high lymph node metastasis rate,staging relatively late,high local recurrence and distant metastasis rate.The treatment follows the principle of comprehensive treatment based on surgery,but the prognosis is poor.Tumor size,lymph node,and radiotherapy treatment affect the prognosis.Overexpression of Ki-67 can be used as a potential diagnostic,therapeutic and prognostic indicator for metaplastic breast cancer.

Male metaplastic breast cancer with poor prognosis:A case report

BACKGROUND Metaplastic breast cancer(MBC)is a rare subtype of breast cancer.They constitute less than 1%of breast cancer cases and are much rarer in males.There are few reports of MBC because of its rarity.MBC,an aggressive type of cancer,is refractory to common treatment modalities of breast cancer and has a poor prognosis.CASE SUMMARY We report a case of MBC in a 78-year-old man.He visited our clinic with a palpable mass on the left breast with no masses in the axillary areas.He had previously undergone robot-assisted laparoscopic radical prostatectomy for prostate cancer,but there was no family history of malignancy.The breast mass was visible on ultrasonography,mammography,and magnetic resonance imaging,and chest computed tomography revealed a lung mass in the posterior basal segment of the right lower lobe.The patient was diagnosed with metaplastic carcinoma on core needle biopsy with lung metastasis.Total mastectomy with sentinel lymph node biopsy and video-assisted segmentectomy of the right lung was performed.However,multiple metastases appeared 3 mo after surgery in the brain,chest,and abdomen,and the patient died 5 mo after the initial diagnosis.CONCLUSION MBC is an aggressive and extremely rare breast cancer type.Further case reports are needed to determine the optimal treatment.

Metaplastic carcinoma of the right breast and simultaneous giant ovarian teratoma:a case report

We describe here a female patient who presented with a breast mass and giant abdominal mass.Fine needle aspiration cytology of the breast mass and histological examination after modified radical mastectomy confirmed metaplastic carcinoma of the breast.The epithelial components were formed by infiltrating ductal carcinoma with poor differentiation,and the sarcomatous components were formed by fibrosarcoma and osteosarcoma.Histological examination of the abdominal mass confirmed ovarian teratoma.The patient underwent modified radical mastectomy of the right breast and laparoscopic excision of the abdominal mass in the lower right quadrant.Having underwent six courses of chemotherapy,the patient is now in her tenth month after surgery and under follow-up,and she has no relapsed disease.These two diseases have never seen in one patient before.The case we report here provides some new data for research and clinical experience and it may also provide a new insight into the relationship between metaplastic breast carcinoma and ovarian teratoma.

Diffusion-tensor imaging as an adjunct to dynamic contrastenhanced MRI for improved accuracy of differential diagnosis between breast ductal carcinoma in situ and invasive breast carcinoma

Objective： To determine the value of diffusion-tensor imaging （DTI） as an adjunct to dynamic contrastenhanced magnetic resonance imaging （DCE-MRI） for improved accuracy of differential diagnosis between breast ductal carcinoma in situ （DCIS） and invasive breast carcinoma （IBC）. Methods： The MRI data of 63 patients pathologically confirmed as breast cancer were analyzed. The conventional MRI analysis metrics included enhancement style, initial enhancement characteristic, maximum slope of increase, time to peak, time signal intensity curve （TIC） pattern, and signal intensity on FS- T2WI. The values of apparent diffusion coefficient （ADC）, directionally-averaged mean diffusivity （D^vg）, exponential attenuation （EA）, fractional anisotropy （FA）, volume ratio （VR） and relative anisotropy （RA） were calculated and compared between DCIS and IBC. Multivariate logistic regression was used to identify independent factors for distinguishing IBC and DCIS. The diagnostic performance of the diagnosis equation was evaluated using the receiver operating characteristic （ROC） curve. The diagnostic efficacies of DCE- MRI, DWI and DTI were compared independently or combined. Results： EA value, lesion enhancement style and TIC pattern were identified as independent factor for differential diagnosis of IBC and DCIS. The combination diagnosis showed higher diagnostic efficacy than a single use of DCE-MRI （P=0.02）, and the area of the curve was improved from 0.84 （95% CI, 0.67-0.99） to 0.94 （95% CI, 0.85-1.00）. Conclusions： Quantitative DTI measurement as an adjunct to DCE-MRI could improve the diagnostic performance of differential diagnosis between DCIS and IBC compared to a single use of DCE-MRI.

Metastatic Lobular Carcinoma of the Breast Presenting with Small Bowel Metastases:Case Report and Literature Review

Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operation. Currently, she is free of disease with no evidence of local, regional, or distant recurrence, and she is still on endocrine therapy. Discussion: The time interval between primary breast cancer and gastrointestinal involvement may range from synchronous presentation to as long as 30 years. The clinical manifestations in GI lobular breast cancer metastasis may range from non-specific complaints to acute GI symptoms, such as a bowel obstruction. There are multiple controversies in the management of ILC. Systemic treatment should be initiated as soon as possible. Indications for postmastectomy radiotherapy are also controversial, given the propensity for multifocal/multicentric tumors and late recurrences, sometimes in atypical locations. Five years of postoperative adjuvant hormonal therapy is an option for women with poor prognosis. Remissions are observed in 32% to 53% of patients. Conclusion: Metastatic lobular carcinoma of the breast has a wide range of clinical presentations. Patients with a history of breast cancer who present with new GI tumors should have these lesions evaluated for evidence of metastasis through histopathologic and immunohistochemical analysis, this will allow for appropriate management. Currently, breast cancer management involves a multidisciplinary approach including surgery, radiotherapy, and systemic medical therapy, and the treatment must be tailored to the patient’s needs.

Pure Mucinous Carcinoma of the Breast:a Clinicopathologic Analysis with 56 Patients

Objective To assess recent trends and prognostic features in the treatment of pure mucinous carcinoma(PMC) of the breast.Methods Fifty-six patients diagnosed with PMC of the breast in our hospital from December 1982 to June 2008 were included.We evaluated the general information and tumor characteristics of the patients,examined the relationship between these factors and prognosis.Fisher's exact test was applied to analyze tumor characteristics.Results The mean age of the patients was 53.7 years.The majority of the patients presented with early stage disease.Tumor size was found not a significant prognostic factor in this study.Mean follow-up period was 39 months and no breast cancer-related deaths were identified in the patient cohort.Conclusions PMC of the breast has a favorable prognosis.Tumor size does not appear to significantly impact survival.

Breast-conserving therapy and modified radical mastectomy for primary breast carcinoma:a matched comparative study

Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.

The Immuno-fluorescence Quantity Analysis of α-Tubulin and γ-Tubulin Protein in Precancerous Lesion and Carcinoma of the Breast and Its Significance

OBJECTIVE To investigate the changes and values of the expression of α-tubulin and γ-tubulin in atypical ductal hyperplasia （ADH）, ductal carcinoma in situ （DCIS） and invasive ductal carcinoma （IDC） of the breast. The relationship between centrosome abnormalities and breast tumor development was further discussed. METHODS There were three groups including ADH, DCIS and IDC with 30 cases in each group. They were analyzed by immuno-fiuorescence quantity analysis. The expression levels of α-tubulin and γ-tubulin protein in these tissues were detected by flow cytometry immuno-fiuorescence analysis and compared with the results from normal tissues. Immunohistochemistry was also performed in this research. RESULTS The results showed significant differences of the average of the positive （FITC labeled） cells （P=0.000） among the four groups. The level of the IDC group was the highest, while normal breast tissue showed the lowest level. The results suggested that the expression levels of α-tubulin and γ-tubulin both increased as the grade of cellular proliferation and differentiation increased. The expressions showed significant differences among all the groups, except between the ADH and DCIS. There were no significant differences between α-tubulin and γ-tubulin expression in each group （P〈0.05）, as there was agreement in the immuno-fluorescence and immunohistochemical analysis for protein expression. CONCLUSION There is abnormal expression of centrosome tubulin as an early event in the development of breast tumor. Furthermore these aberrations may play a key role during oncogenesis and promote cellular transformation to malignancy. The immuno-fiuorescence quantitive analysis and immunohistochemistry can complement each other.

Metaplastic breast cancer with chondrosarcomatous differentiation combined with concurrent bilateral breast cancer:A case report

BACKGROUND Metaplastic breast carcinoma(MBC)is a rare subtype of invasive breast cancer comprising malignant epithelial and mesenchymal cells.Compared with other invasive breast cancers,MBC is not only histologically distinctly heterogeneous but also has a rapid and aggressive growth pattern,which leads to a significant risk of recurrence and mortality.CASE SUMMARY In this study,we report the case of a patient with a large left breast mass diagnosed with bilateral invasive ductal carcinoma in both breasts after a preoperative core needle aspiration biopsy of the bilateral breast mass.The patient received neoadjuvant chemotherapy and underwent bilateral breast modified radical mastectomy.Postoperative pathology suggested carcinosarcoma with predominantly chondrosarcoma in the left breast and invasive ductal carcinoma(luminal B)in the right breast.As the patient did not achieve complete pathological remission after six cycles of neoadjuvant chemotherapy,we administered six months of intensive capecitabine treatment.Then the patient was switched to continuous treatment with endocrine therapy using letrozole+goserelin,and the patient is currently in stable condition.However,as MBC of the breast is concurrently diagnosed with chondrosarcoma differentiation,our case is sporadic.CONCLUSION Given the variety of immunohistochemical types of bilateral breast cancer,achieving effective chemotherapy should be a key research focus.

Breast adenoid cystic carcinoma arising in microglandular adenosis:A case report and review of literature

BACKGROUND Breast adenoid cystic carcinoma(AdCC)is a rare invasive carcinoma composed of epithelial and myoepithelial cells.Microglandular adenosis(MGA)is a rare benign proliferative lesion consisting of small,uniform,and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer.MGA may progress to atypical MGA and carcinoma arising in MGA.Among various invasive carcinomas from MGA,AdCC has been rarely reported.Here,we report a case of AdCC arising in MGA.CASE SUMMARY A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram.The density was similar to or slightly lower than that of the breast parenchyma.Sonography showed an irregular mass with a slightly higher echo than that of fat.Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma.The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern.Microscopically,the tumor was composed of invasive AdCC,in situ AdCC,and MGA.AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets,or haphazardly scattered small cribriform or tubular glands.MGA showed small glands with a single epithelial lining and retained lumen.S-100 staining was strongly positive in MGA area.The patient underwent breast-conserving surgery with sentinel lymph node biopsy.CONCLUSION Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.

Migration of the localization wire to the back in patient with nonpalpable breast carcinoma: A case report

BACKGROUND Due to the increasing number of diagnosed nonpalpable breast cancer cases,wire localization has been commonly performed for surgical guidance to remove nonpalpable breast lesions.This report presents a rare case of localized wire migration to a subcutaneous lesion of the upper back in a breast cancer patient undergoing breast-conserving surgery.CASE SUMMARY A 48-year-old female was scheduled for breast-conserving surgery for left breast cancer.Ultrasonography guided wire localization was performed intraoperatively by surgeon to localize the nonpalpable breast cancer.After axilla sentinel lymph node biopsy,we realized that the wire was not visualized.The wire was not found in the operation field,including the breast and axilla.Breast-conserving surgery was performed after wire re-localization.Intraoperative chest posteroanterior view revealed that the wire was located on the level of midaxillary line.Two days after the operation,a serial simple X-ray revealed that the wire was located on the subcutaneous lesion of the back.The wire tip was palpable under the skin of the upper back,and the wire was removed under local anesthesia.CONCLUSION Hooked wire misplacement can lead to fatal complications.Surgeons must consider the possibility of wire migration during breast cancer surgery.

Expression of Presenilin-2 and Glutathione S Transferase π and Their Clinical Significance in Breast Infiltrating Ductal Carcinoma

To investigate the expressions of presenilin-2 (PS2) and glutathione Stransferase π (GSTπ) and their roles in prognosis and therapy of breast infiltrating ductalcarcinoma. Methods: The paraffin-embedded specimens of 210 patients with breast infiltrating ductalcarcinoma were examined by using LSAB immunohistochemistry for the expression of PS2 and GSTπ.Results: The expression rate of PS2 and GSTπ was 49.5% (104/210) and 48.1% (101/210) respectively.The 5-year and 10-year postoperative survival rates in 4 groups, from high to low, were group 1 (PS2positive expression/GSTπ negative expression), group 2 (PS2 positive expression/GSTπ positiveexpression), group 3 (PS2 negative expression/GSTπ negative expression) and group 4 (PS2 negativeexpression/GSTπ positive expression) in turn. Conclusion: The prognosis of the group 1 was thebest, followed by the group 2, group 3 and group 4 in turn. These results suggested that thereasonable use of endocrinotherapy and chemotherapy for patients with breast infiltrating ductalcarcinoma is necessary.

Clinicopathological Study of Epithelial Metaplastic Breast Cancer

Introduction: Metaplastic breast cancer (MBC) is a rare pathological type with an incidence rate of not more than 1%, and has been reported to be often detected after its progression and highly malignant with a high proportion of triple negative type tumors, with poor outcomes as compared to IDC [1] [2] [3]. We analyzed clinicopathological characteristics of patients who underwent surgery for epithelial MBC at our department. Patients and Methods: From January 2000 to March 2014, a total of 2120 patients underwent surgery for breast cancer, and MBC was diagnosed in 15 of these patients. Fourteen of the 15 had epithelial MBC and were included in this study. The present study compared clinopathological characteristics of MBC with those of IDC of triple negative type (TN type group) and IDC of non-triple negative type (IDC group). Results: Breast conserving surgery was performed in 7 patients with MBC (50%), a proportion clearly lower than the 64.3% in the IDC group. The mean tumor size was 3.8 cm, which was greater than the 2.13 cm in the TN type group and the 1.7 cm in the IDC group. About nuclear grade, the proportion of grade III was 57.1%, markedly higher than the 38.6% in the TN type group and the 12.6% in the IDC group. All patients were estrogen receptor (ER) and progesterone receptor (PgR) negative;11 patients were TN type tumors and 3 were HER2 type. Conclusion: We studied patients who underwent surgery for epithelial MBC. The examined cases showed clinopathological characteristics of the disease, including large tumors with a highly malignant nature at the initial detection, higher Ki-67 levels, ER and PgR negativity (all cases), mostly TN type, and a high recurrence rate.

Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance:A case report

BACKGROUND Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance(MGUS)is rare and easily misdiagnosed.Most patients are first diagnosed with MGUS.We report a rare case of MGUS secondary to infiltrating ductal breast carcinoma.We also review the literature to analyze the clinical characteristics and diagnostic methods.CASE SUMMARY A 51-year-old woman underwent modified radical mastectomy for infiltrating ductal carcinoma of the right breast and was then treated with radiation and chemotherapy.A decreased platelet count was found on routine blood examination,and MGUS was subsequently diagnosed.This is the first report of the occurrence of MGUS after breast cancer surgery.CONCLUSION Vigilance is required to distinguish this rare comorbidity from breast plasmacytoma.