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.

Liposarcoma of the breast arising in a malignant phyllodes tumor:A case report and review of the literature

Liposarcoma of the breast is a very rare malignant tumor. It can clinically manifest as a palpable breast mass and mimic primary breast cancer. We report an unusual case of a 51-year-old female who presented with an asymptomatic right breast mass, which was histologically diagnosed as well differentiated liposarcoma arisen within malignant phyllodes tumor. The patient underwent breast conserving surgery, received no adjuvant treatment and is disease-free after 2 years. Radiological and histopathological features are presented and described in detail. Data from the literature are presented and therapy recommendations discussed.

Adenomyoepithelioma of the breast with malignant transformation and repeated local recurrence:A case report

BACKGROUND Adenomyoepithelioma(AME)of the breast is a rare type of benign breast tumor.Many AMEs show benign behavior,but reports of the malignant type are rare.We present the case of a patient with AME with repeated local recurrences and further malignant transformation.CASE SUMMARY A 53-year-old woman visited our hospital with a 16-mm palpable mass in the right breast.A core needle biopsy was performed.The pathological diagnosis was AME.Lumpectomy with a safety margin was performed without axillary lymph node dissection(ALND).Two years later,local recurrence developed,and the patient again underwent lumpectomy with a safety margin.The pathology showed malignant AME,and the margin was negative.Eight months later,local recurrence developed again in the same location,and a total mastectomy was performed without ALND.The pathological diagnosis was malignant AME.The patient was disease-free for three years posttreatment.CONCLUSION The treatment of AME requires caution,as it may exhibit repeated recurrences after local excision as well as malignant transformation.

A RETROSPECTIVE ANALYSIS OF SURGICAL TREATMENT FOR BREAST MALIGNANT TUMORS

Objective: To review the evolution of the current surgical treatment for breast malignant tumors over the past twenty years in the First Hospital of Jilin University (the former Bethune University of Medical Sciences). Methods: 1195 eligible patients with primary breast malignant tumor diagnosed and surgically treated at the First Teaching Hospital from January 1980 and December 2000 were retrospectively analyzed. Results: The peak frequency was in 40–49 years of age (40.00%), the age of the patients with breast malignant tumors trends to become young. The most common pTNM classification was Stage II. The most common histological type was infiltrating ductal carcinoma (398 patients, 33.31%), and simple carcinoma (279 patients, 23.53%). Modified radical mastectomy was the most common operation procedure performed (779 patients, 65.19%), and was increasingly used while radical mastectomy was adopted decreasingly in recent decade. Conclusion: The variation of operation procedures performed on patients with breast malignant tumors reflected the advance of our understanding of the biology of cancer and the progression of new treatment principles.

Primary Malignant Peripheral Nerve Sheath Tumor of the Breast—A Case Report

Malignant peripheral nerve sheath tumor is a rare soft tissue sarcoma. Breast is an extremely rare location of this lesion and presentation as a breast lump in the absence of pain or previous benign neural tumor is even rarer. We report such a lesion in a 60 year-old female who presented with hard and painless breast lump for 2 years. Histopathology revealed a malignant spindle cell tumor of low grade potential. It was subsequently confirmed to be malignant peripheral nerve sheath tumor (MPNST) on the basis of immunopositivity for vimentin, neurone specific enolase and S-100.

Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Voluminous Phyllode Tumour of the Breast: A Case Report and Literature Review from Loandjili General Hospital in Pointe-Noire, Congo

Introduction: Breast phyllodes are rare. Histologically, it is a fibro-epithelial tumour that differs from the fibro-adenoma by a more abundant and more cellular stroma. Observation: We report a case of a large breast phyllode tumour in a 42-year-old woman in the Obstetric and Gynaecology Department of Loandjili General Hospital. This tumor has evolved for 3 years. It is by discomfort due to chest pain. The clinical examination showed a voluminous right breast in the form of a calabash that hung down the body with a large collateral circulation, associated with an appearance of “orange peel”, and an axillary lymph node. In addition, there were necrotic areas and retraction of the nipple. In addition to the clinical characteristics, the ultrasound images and the histological analyses following the biopsy made it possible to evoke the diagnosis of phyllode tumour of the breast. The treatment consisted of a full right simple mastectomy with a 50 cm breast with a major axis that weighed 9465 grams, supplemented by homolateral axillary lymph node dissection. At the section of the tumour measuring 40 cm long, the sectional sections alternately showed solid and cystic areas. The histological examination confirmed the phyllode nature of the tumour with intermediate grade 2 malignancy. The lymph nodes showed an inflammatory appearance, with no signs of malignancy. Early post operation period was uneventful. The patient’s follow-up was annual, and the last check dated 09/01/2017 proved to be normal. Conclusion: The phyllode tumor is a rare pathology. In our environment, it can be greatly increased by the lack of diagnosis and early management. In all cases, any tumour of the breast operated, must benefit from an anatomo-pathological analysis, to determine the benign or malignant character of it, allowing proposing a plan of management better adapted.

Diagnosis of an extremely rare case of malignant adenomyoepithelioma in pleomorphic adenoma:A case report

BACKGROUND Pleomorphic adenoma(PA)is the most common type of salivary gland tumor,and its common sites are parotid gland,sinus,nasal septum and cleft palate.PA is an uncommon benign type of tumor occurring in the breast,and there are few reports of cases in Asia.CASE SUMMARY An 84-year-old woman found a mass in the upper outer quadrant of the right breast>1 year ago.The patient underwent a right breast lumpectomy and sentinel lymph node biopsy.The pathological diagnosis was PA in the upper outer quadrant of the right breast,and the malignant component was malignant adenomyoepithelioma.The postoperative course was uneventful,and no chemotherapy was administered.At 18 mo of follow-up,the patient is alive and well,with no evidence of recurrent disease.CONCLUSION Patients with breast PA should first undergo extended excision of breast masses followed by pathological examination.If malignancy is confirmed or the surgical margin is positive,modified radical mastectomy should be performed.

CD146 promotes malignant progression of breast phyllodes tumor through suppressing DCBLD2 degradation and activating the AKT pathway

Background As a rapid-progressing tumor,breast malignant phyllodes tumors(PTs)are challenged by the lack of effective therapeutic strategies and suitable prognostic markers.This study aimed to clarify the role and mechanism of CD146 on promoting PTs malignant progression,and to identify a novel prognosis marker and treatment target of breast malignant PTs.Methods The expression and prognostic significance of CD146 in PTs was detected through single-cell RNA-sequencing(scRNA-seq),immunostaining,real-time PCR and other methodologies.Functional experiments including proliferation assay,colony formation assay,transwell assay,and collagen contraction assay were conducted to validate the role of CD146 in malignant progression of PTs.The efficacy of anti-CD146 monoclonal antibody AA98 against malignant PTs was corroborated by a malignant PT organoid model and a PT patient-derived xenograft(PDX)model.Transcriptome sequencing,proteomic analysis,co-immunoprecipitation,and pull-down assay was employed to identify the modulating pathway and additional molecular mechanism.Results In this study,the scRNA-seq analysis of PTs disclosed a CD146-positive characteristic in theα-SMA+fibroblast subset.Furthermore,a progressive elevation in the level of CD146 was observed with the malignant progression of PTs.More importantly,CD146 was found to serve as an independent predictor for recurrence in PT patients.Furthermore,CD146 was found to augment the viability and invasion of PTs.Mechanistically,CD146 acted as a protective“shield”to prevent the degradation of Discoidin,CUB,and LCCL domain-containing protein 2(DCBLD2),thereby activating the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)signaling pathway and enhancing malignant behaviors of PT cells.In the malignant PT organoid and PDX model,a significant suppression of malignant PT growth was observed after the application of AA98.Conclusions These findings suggested that CD146 served as an efficacious marker for predicting PT malignant progression and showed promise as a prognosis marker and treatment target of breast malignant PTs.The study further unveiled the essential role of the CD146-DCBLD2/PI3K/AKT axis in the malignant progression of PTs.

A pulmonary metastatic breast phyllodes tumor and clinicopathology analysis

Objective Breast phyllodes tumors(PTs) are rare fibroepithelial tumors that are characterized by formation of foliation patterns. Behaviorally, only relatively poor prediction of PTs is possible based on their histological appearance. PTs are frequently misdiagnosed because they are difficult to differentiate from soft tissue tumors. In this report, we describe the pathological features of a rare case of PT and review the relevant literature, summarizing the essentials of the diagnosis and differential diagnosis, while attempting to avoid misdiagnosis or missed diagnosis of the tumor to the best of our abilities.Methods We present a case of pulmonary metastatic lobular tumor, analyzing the morphological [hematoxylin-eosin(HE) staining] and immunohistochemical(streptavidin perosidase method, SP) features of the tissue.Results Long spindle-shaped tumor cells were observed using microscopy. The cells were arranged in bundles, with a whirlpool pattern, and braided. The proliferation of the spindle cells was markedly atypical and karyokinesis was elevated. Residual ductal epithelium was detected in some areas, and the margins of the tumor tissues showed invasive growth. Immunohistochemical studies of the spindle-shaped tumor cells were positive for actin, PR, CD10, SMA, Bcl-2, and negative for CKP, S-100, CD34, ER. The Ki-67 index was 40%.Conclusion The spindle cell tumor identified in the lung should first be considered as a metastatic neosplasm, because most soft-tissue sarcomas commonly metastasize through the bloodstream to the lungs. Although malignant breast PTs are rare, a detailed medical history that includes prior surgical history is required to avoid wrongful or missed diagnosis.

Malignant phyllode tumor metastatic to the duodenum

叶状叶柄肿瘤(磅) 是胸的极其稀罕的肿瘤。远转移与恶意的叶状叶柄肿瘤发生在病人的 10%-20% 。转移的最普通的地点是肺和骨头。尽管理论上任何机关可以有转移，孤立的十二指肠转移没在英语语言的文学迄今为止被记录。我们此处在 31 year-old-woman 从胸的磅与孤立的十二指肠的转移报导一个案例因为周期性的恶意的磅，以前恰好经历了乳房切除术 4 年。她介绍了给我们的医院与巨大上面的胃肠的流血。临床的评估表明一个巨大的团从十二指肠发源。迫切剖腹术和 pancreaticoduodenectomy 被执行以便移开流血十二指肠的质量。resected 标本的病理学的考试显示出与变形的恶意的磅一致的一个恶意的锭子房间肿瘤。我们从胸的恶意的叶状叶柄肿瘤的由于造血的传播的由于孤立的十二指肠的转移的胃肠的流血的案例在英语文学是唯一的， pancreaticoduodenectomy 是为有孤立的十二指肠的参与的病人的祛病疗法。

超声乳腺影像报告和数据系统联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤

目的观察超声乳腺影像报告和数据系统(BI-RADS)联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤(PTB)的价值。方法回顾性分析74例经乳腺超声检查及术后病理证实的PTB女性患者共76个病灶,包括良性57个、交界性14个及恶性5个,比较3种病变患者年龄及其超声BI-RADS分类,观察以单一年龄、超声BI-RADS及其联合鉴别诊断价值。结果良性、交界性及恶性PTB之间,患者年龄及超声BI-RADS分类差异均有统计学意义(P=0.026、0.015)。以44.5岁、超声BI-RADS 4B类及其联合鉴别良性与交界性/恶性PTB的敏感度分别为94.74%、36.84%及73.68%,特异度分别为56.36%、87.27%及72.73%,曲线下面积分别为0.769、0.649及0.780。结论超声BI-RADS分类联合患者年龄有助于鉴别良性与交界性/恶性PTB。

基于瘤体及瘤周多参数MRI对乳腺病变良恶性诊断列线图预测模型的构建与评价

目的:建立基于瘤体及瘤周多参数MRI的乳腺病变良恶性鉴别诊断的列线图模型,并验证其预测效能。方法:纳入经病理学检查明确乳腺病变性质的100例患者作为研究对象,所有患者均行核磁共振(MRI)检查和病理检查,根据病理检查结果分为乳腺良性病变组(n=62)和乳腺恶性病变组(n=38)。收集患者临床资料、瘤体各参数、瘤周各参数以及乳腺病变良恶性情况。多因素Logistic回归分析筛选乳腺恶性病变的危险因素并构建列线图预测模型,采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验验证模型的预测效能及拟合优度;内部验证采用Bootstrap。结果:乳腺恶性病变组病灶直径、平均扩散峰度(MK)、MDp/t、瘤周与瘤体MKp/n高于乳腺良性病变组(均P<0.05);乳腺恶性病变组表观扩散系数(ADC)值、平均扩散率(MD)、非对称磁化转移率(MTRasym)、MKp/t、MDp/n低于乳腺良性病变组(均P<0.05)。多因素分析结果显示,病灶直径、MK、MDp/t、MKp/n升高,ADC值、MD、MTRasym、MKp/t、MDp/n降低是乳腺恶性病变的独立影响因素(均P<0.05)。基于上述独立影响因素构建乳腺恶性病变的列线图预测模型,曲线下面积(AUC)为0.827。Hosmer-Lemeshow拟合优度检验显示P值为0.004。采用Bootstrap法,生成的校准曲线拟合良好。结论:瘤体及瘤周多参数MRI对乳腺病变良恶性鉴别诊断具有重要预测价值,基于乳腺恶性病变的独立影响因素构建的列线图预测效果良好,能直观预测乳腺发生恶性病变的概率。

乳腺癌脑转移分子机制的研究进展

乳腺癌(BC)是女性最常见的恶性肿瘤之一,其发病率和死亡率在全球大多数国家女性肿瘤中排名第一。BC患者的高死亡率与骨、肺、脑和肝等远端器官的复发和转移有关。目前已知乳腺癌发生脑转移的有关信号通路有PI3K/Akt/mTOR通路、Wnt/β-catenin通路、RAS/ERK通路、EGFR通路、STAT3通路、NF-κB通路、ROS/NF-κB通路及PDGFB/PDGFR-β通路。此外,有关研究发现外泌体、非编码RNA以及代谢成分等物质可通过破坏血脑屏障、协助建立脑转移微环境来参与乳腺癌的脑转移。本文对乳腺癌脑转移的可能分子机制和信号通路进行综述,旨在为乳腺癌脑转移的精准靶向治疗提供新思路。

西黄丸辅助白蛋白结合型紫杉醇联合环磷酰胺化疗对乳腺癌患者免疫功能的影响

目的:观察西黄丸辅助白蛋白结合型紫杉醇联合环磷酰胺(TC)化疗方案对乳腺癌患者术后免疫功能的影响。方法:选取2021年1月1日~2023年5月1日某院甲乳外科收治的78例乳腺癌术后行TC化疗方案的患者为研究对象,采用随机数字表法分为对照组和观察组,每组39例。对照组给予TC化疗方案进行治疗,观察组在对照组治疗基础上加用西黄丸。治疗2个周期后,比较两组患者免疫指标[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、自然杀伤(NK)细胞]水平变化。结果:治疗后,观察组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、NK细胞水平均高于对照组(P<0.05),CD8^(+)水平低于对照组(P<0.05)。结论:西黄丸辅助TC化疗可通过调节CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、NK细胞水平,改善行TC化疗的乳腺癌患者术后免疫功能,建议临床推广。

基于超声图像特征的列线图模型预测乳腺叶状肿瘤Ki-67表达水平的临床价值

目的基于超声图像特征构建列线图模型,探讨其预测乳腺叶状肿瘤(PTB)Ki-67表达水平的临床价值。方法选取我院经术后病理证实的PTB患者119例,根据Ki-67表达水平分为Ki-67低表达组(Ki-67≤10%)82例和Ki-67高表达组(Ki-67>10%)37例。比较两组超声图像特征的差异,包括最大径、纵横比、形态、边缘、实质回声、囊变、钙化、后方回声、血流信号、阻力指数、收缩期峰值流速;应用多因素Logistic回归分析筛选预测Ki-67高表达水平的独立预测因子,基于独立预测因子构建列线图模型。采用Bootstrap自助抽样法进行内部验证,绘制受试者工作特征(ROC)曲线分析模型的区分度;采用Hosmer-Lemeshow检验并绘制校准曲线评估模型的校准度;临床决策曲线分析模型的临床适用性。结果两组最大径、囊变、血流信号、收缩期峰值流速比较差异均有统计学意义(均P<0.05);两组纵横比、形态、边缘、实质回声、钙化、后方回声、阻力指数比较差异均无统计学意义。多因素Logistic回归分析显示,最大径、囊变和收缩期峰值流速均为预测Ki-67高表达水平的独立影响因子(OR=1.164、0.078、1.404,均P<0.05),根据上述独立预测因子构建列线图模型。ROC曲线分析显示,列线图模型预测PTB患者Ki-67高表达水平的曲线下面积(AUC)为0.812(95%可信区间:0.704~0.920);Hosmer-Lemeshow检验显示,列线图模型预测概率与实际概率比较差异无统计学意义(P=0.330);校准曲线显示,预测曲线与校准曲线的校准度较高,C-index为0.814(95%可信区间:0.710~0.913);临床决策曲线分析显示,当阈值为0.10~0.48时,该模型的临床获益较高。结论基于超声图像特征的列线图模型可用于预测PTB患者Ki-67表达水平,该模型具有较高的准确性和可靠性。

超声造影与磁共振成像对乳腺叶状肿瘤病理亚型的诊断效能对比

目的:探究超声造影与核磁共振成像(contrast-enhanced ultrasound and magnetic resonance imaging, MRI)在诊断乳腺叶状肿瘤(phyllodes tumor of the breast, PTB)良恶性方面的诊断效能。方法:回顾性分析39例PTB(病理诊断)的超声造影和MRI特征,比较两种检查方法的诊断效能。结果:良性叶状肿瘤27例,交界性5例,恶性7例。PTB超声造影多呈向心性不均匀高增强伴灌注缺损、增强后边界清晰,其中增强强度、灌注缺损在三组间差异明显(P=0.015、0.009)。PTB的MRI特征以T2WI低信号裂隙、强化不均匀及Ⅱ型TIC曲线类型为主;且T2WI低信号分隔、强化特征及ADC值差异具有统计学意义(P=0.027、0.001、0.042)。MRI对PTB的诊断效能高于CEUS,但差异无统计学意义。结论:超声造影在PTB的表现上具有一定特征性,在诊断PTB良恶性方面与MRI具有较好的一致性。

广藿香抗肿瘤的研究进展

广藿香是一种常见的传统中草药,临床应用上具有抗菌抗炎,抗氧化等功效,随着研究深入发现其还具有抗肿瘤功效。通过调控凋亡基因及细胞周期等,抑制肿瘤细胞增殖,是基于恶性肿瘤常规治疗副作用及耐药性的辅助用药。本文将从该药物的理化性质,药理作用,抗肿瘤机制,以及对乳腺癌治疗的相关性进行论述。

乳腺交界性及恶性叶状肿瘤患者临床病理特征及预后分析

目的探讨乳腺交界性叶状肿瘤(BPT)及恶性叶状肿瘤(MPT)的临床病理特征及预后影响因素。方法回顾性选取2017年7月至2023年6月中国医学科学院肿瘤医院收治的111例乳腺BPT及MPT患者的临床资料,分析其临床病理特征、复发转移情况及无复发生存率的影响因素。结果111例患者中,20例出现局部复发,4例发生远处转移。接受非全切手术的88例患者中,行肿物区段切除术(无切缘检查)和肿物扩大切除术(有切缘检查)的患者复发率分别为31.0%和10.9%,差异有统计学意义(P=0.020)。单因素生存分析显示,BPT及MPT患者的无复发生存率与组织学类型有关(P=0.004),与初治肿瘤最大径(P=0.080)、平均核分裂象计数(P=0.153)及手术方式(P=0.204)无明显相关性。Cox多因素分析结果显示,MPT患者的复发风险是BPT患者的4.894倍(95%CI 1.857~12.901,P=0.001)。结论乳腺MPT较BPT具有更高的复发风险。手术治疗应在保证完整切除肿瘤的基础上适当扩大切除范围,并至少保证切缘阴性。

磁共振成像联合超声弹性成像在乳腺良恶性肿瘤鉴别诊断中的价值

目的:分析磁共振成像联合超声弹性成像鉴别诊断乳腺良恶性肿瘤的效果。方法:收集2022年8月—2023年8月聊城市传染病医院收治的98例乳腺肿瘤患者资料开展回顾性分析。患者术前均进行超声弹性成像、磁共振成像检查。以病理诊断结果为金标准,分析超声弹性成像、磁共振成像单一检查与联合检查对乳腺肿瘤的诊断效能;通过Kappa系数评价不同检查方法与病理诊断的一致性。结果:(1)病理诊断结果显示,98例乳腺肿瘤患者中恶性55例(恶性组),良性43例良性(良性组)。超声弹性成像检查中良性组1~3分人数占比高于恶性组,4~5分人数占比低于恶性组(P<0.05)。(2)磁共振成像检查中良性组病灶形态片状、圆形人数占比高于恶性组,边缘毛刺、不规则人数占比低于恶性组(P<0.05)。(3)超声弹性成像、磁共振成像联合检查的灵敏度、准确率、阳性预测值、阴性预测值高于超声弹性成像单一检查(P<0.05)。(4)超声弹性成像诊断与病理诊断一致性尚可(Kappa值=0.508),磁共振成像与病理诊断一致性较好(Kappa值=0.855),联合检查与病理诊断一致性极好(Kappa值=0.896)。结论:乳腺良恶性肿瘤鉴别诊断采取磁共振成像、超声弹性成像联合检查有更理想诊断效能。