Clinicopathological features,psychological status,and prognosis of 33 patients with occult breast cancer

BACKGROUND Occult breast cancer(OBC)has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer.Due to the small number of cases and limited clinical experience,treatments vary greatly around the world and no standardized treatment has yet been established.AIM To investigate the clinicopathological features,psychological status and prognostic features of patients with OBC.METHODS The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed.The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale.Patients’emotions,stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule,the Chinese Perceived Stress Scale,and the Connor-Davidson Resilience Scale(CD-RISC),respectively.Patient survival was calculated using the Kaplan-Meier method,and survival curves were plotted for analysis with the log-rank test.Univariate and multivariate survival analyses were performed using the Cox regression model.RESULTS The 33 OBC patients included 32 females and 1 male.Of the 33 patients,30(91%)had axillary tumors,3(9%)had a neck mass as the primary symptom;18(54.5%)had estrogen receptor-positive tumors,17(51.5%)had progesterone receptor-positive tumors,and 18(54.5%)had Her-2-positive tumors;24(72.7%)received surgical treatment,including 18 patients who underwent modified radical mastectomy,1 patient who underwent breast-conserving surgery plus axillary lymph node dissection(ALND),and 5 patients who underwent ALND alone;12 patients received preoperative neoadjuvant therapy.All 30 patients developed anxiety and depression,with low positive affect scores and high negative affect scores,accompanied by a high stress level and poor psychological resilience.There were no differences in the psychological status of patients according to age,body mass index,or menopausal status.The overall survival and disease-free survival(DFS)of all the patients were 83.3%and 55.7%,respectively.Univariate analysis demonstrated that the initial tumor site(P=0.021)and node stage(P=0.020)were factors that may affect patient prognosis.The 5-year DFS rate of OBC patients who received radiotherapy was greater(P<0.001),while the use of different surgical methods(P=0.687)had no statistically significant effect on patient outcomes.Multivariate analysis revealed that radiotherapy(P=0.031)was an independent prognostic factor.Receiving radiotherapy had a significant effect on the CD-RISC score(P=0.02).CONCLUSION OBC is a rare breast disease whose diagnosis and treatment are currently controversial.There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy.In addition,radiotherapy can significantly improve patient outcomes.We should pay attention to the psychological state of patients while they receive antitumor therapy.

Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer:A case report and review of literature

BACKGROUND Occult breast cancer(OBC)is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast.Due to its low incidence and unique clinical manifestations,there is a lack of consensus on the diagnosis and treatment of OBC.We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib.The treatment was well tolerated,and the patient achieved a pathologic complete response.CASE SUMMARY A 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast.Pathological biopsy confirmed right axillary metastatic carcinoma.Immunohistochemical staining results were positive for progesterone receptor,cytokeratin 7,specific breast markers GATA3 and gross cystic disease fluid protein-15.Tumor cells were negative for estrogen receptor,human epidermal growth factor receptor-2,cytokeratin 5/6,cytokeratin 20,and villin.The patient was diagnosed with OBC,and she underwent neoadjuvant chemotherapy combined with anlotinib.Mastectomy plus axillary lymph node dissection was performed.The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes.Postoperatively,she received adjuvant radiotherapy and endocrine therapy.CONCLUSION Neoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.

Intratumoral heterogeneity of HER2 gene amplification in occult breast cancer

Occult breast cancer （OBC） is an uncommon type of breast cancer, with palpable masses in the axillary area as the initial symptom. We report a case of OBC with HER2 genetic heterogeneity and discuss the impact of an unusual HER2 amplification pattern.A 56-year-old female was discovered a palpable mass in the right axillary area. She underwent a lymph node excisional biopsy at another hospital approximately one month before referral to our hospital service for further evaluation. The biopsy showed lymph tissue with tumor cell infiltrating in the form of sheets or nests. The tumor cells were larging in size, obviously atypical, and showed prominent nucleoli and intracellular keratosis. Mammography, chest X-ray, chest computed tomography （CT）, abdominal ultrasonography （US）, and positron emission tomography- CT （PET-CT）, which were also performed at the initial hospital, showed no abnormal findings.

Clinical and pathological portraits of axillary presentation breast cancer and effects of preoperative systemic therapy

There is a lack of investigation into the biological characteristics and preoperative systemic therapy （PST） for occult breast cancer （OBC）. For this study, departmental records in Breast Disease Center of Peking University First Hospital from January 2008 to December 2015 were retrospectively reviewed to identify cases of OBC. Eleven cases were included, and all patients were female, with a median age of 56 （range： 29-75） years. The sensitivity of magnetic resonance imaging （MRD was I00%, and the false positive rate was 33.3%. Based on histologic analysis of the axillary node, 9 （81.8%） cases were grade 3, and 2 （18.2%） cases were grade 2; 4 （36.4%） cases were 〉10% estrogen receptor （ER） positive and 6 （54.5%） human epidermal growth receptor 2 （HER2） positive. Nine cases （81.8%） exhibited over 30% Ki67 expression. PST was performed in 5 of the 11 cases. The lymph node response rate was 100% （5/5）, but no complete remission was achieved. In conclusion, aggressive subtypes were predominant among the included cases, and PST should be considered for OBC treatment options.

Presentation of Axillary Metastases from Occult Breast Carcinoma

Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confi rmed, a preoperative workup should be done. The current experience is based on several relatively small retrospective reviews and case reports. It is diffi cult to determine the best management of occult breast cancer. However, treatment of axillary lymph node dissection is recommended for local control and complete staging information. Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy. Adjuvant systemic treatment should be offered.

DETECTION OF OCCULT TUMOR CELLS IN RESECTED LYMPH NODES OF PATIENTS WITH STAGE I CARCINOMA AND ITS CLINICOPATHOLOGICAL SIGNIFICANCE

Objective: A lot of 3715 resected lymph nodes from 350 stage I cancer patients, including 94 NSCLC, 112 breast carcinoma, 115 esophageal carcinoma, and 29 vulvar carcinoma cases, were re examined by immuno histochemistry. Methods: Using monoclonal anti cytokeratins (AE1/AE3), anti EMA, and polyclonal anti keratin antibodies, the tumor cell micrometastases were detected to obtain more reliable information concerning the nodal status. Results: Nodal occult metastases were observed in 113 of 350 (32.5%) patients and in 203 of 3715 (5.5%) nodes. The positive rates in both patients and nodes were higher in NSCLC than in others (P<0.05). The nodal occult metastases were seen in 58% of pulmonary squamous cell carcinoma and 53.8% of adenocarcinoma, while they were seen in 22.5% of esophageal and 10.3% of vulvar squamous cell carcinomas and in 27.7% of breast adenocarcinoma (P<0.05). Follow up of a part of breast carcinoma patients showed that the clinical prognosis was worse in patients with positive nodes than in negative ones (P< 0.05 ). Conclusion: The data suggested that the immunohistochemical techniques can significantly facilitate the detection of micrometastatic tumor cells in lymph nodes. The frequency of nodal occult metastases may have important impact on the clinical prognosis of cancer patients.

Tumor-Specific Histo-Blood Group Antigens: Apropos of Two Cases

Cancer cells with immunogenic properties having altered protein glycosylation, modified blood group substances have been widely studied. Due to the genetic instability occurring during carcinogenesis the glycosyltransferases may suffer from posttranslation sequence modification. The author describes 2 autopsy cases, where in the background of the unusual metastatic tumor presentation, incompatible blood group antigenic determinants have been demonstrated using blood group specific lectins and monoclonal antibodies (mAb). In the first case, reported here, a 10-year-old girl developed an acute myeloid leukemia and died in a septic endotoxin shock after successful cytostatic treatment of a juvenile signet ring cell cancer of her colon. At autopsy there were no signs of tumor except bilateral apple-sized mucinous ovarian (Krukenberg) metastases. While she had erythrocyte phenotype of blood group A, the signet ring adenocarcinoma cells expressed blood group B incompatible antigenic determinants with lectin/mAb. In the second case, the autopsy of a 78-year-old female resulted in no macroscopic tumor sign except a moderately enlarged, ham hard spleen. Light microscopy revealed adenocarcinomatous infiltration in the splenic sinusoids. The patient had blood group O, while the metastatic cells in the spleen reacted with Breast Carcinoma Antigen (BioGenex) and incompatible anti-B Banderiaeasimplicifolia agglutinin I and anti-B mAb. It proved to be a case of an occult, completely regressed breast cancer. Based on these observations the expression of tumor specific incompatible blood group antigens might occur from time to time, mostly in adenocarcinomas. Accordingly, blood group-based specific immuno-oncotherapy could be considered in some cancer cases.

男性隐匿性乳腺癌甲状腺转移1例并文献复习

目的男性隐匿性乳腺癌(male occult breast cancer,MOBC)在临床上罕见,发病率远低于女性乳腺癌,占全部乳腺癌患者的0.5%~1%。对本病认识不足常导致延误诊治,因此需重视MOBC的临床病理特征、治疗策略及生存情况。方法本文报道2022年7月菏泽市牡丹人民医院收治的1例57岁MOBC。回顾性分析该患者的诊断及治疗过程和生存情况,并复习相关文献,供临床医师参考。结果患者57岁,临床上表现为右颈部肿块,行双侧甲状腺肿瘤切除术,术后病理为乳腺浸润性癌(TxN3M1Ⅳ期,HR阴性HER-2阳性),术后进展制订方案“曲妥珠单抗+帕妥珠单抗+紫杉醇脂质体”6周期,HP维持,4周期评估大PR。结论MBC病因尚未明确,迄今尚无标准的筛查指南。MBC与乳腺癌家族史、BRCA2基因突变及体内雌激素失衡等因素密切相关,检查方法首选超声检查及钼靶检查,对高度可疑癌变的肿瘤应尽早行穿刺活检明确诊断,病理类型多为浸润性导管癌。早发现治疗预后较好,对于MBC治疗依据女性乳癌治疗方案,以手术、放化疗、靶向、内分泌等多种手段在治疗中综合应用。

隐匿性乳腺癌7例临床分析及文献复习

背景与目的:隐匿性乳腺癌是临床较少见的特殊类型乳腺癌,本文拟就其诊断、治疗和预后作一探讨。方法:选择自1990年5月-2001年5月在我院胸外科收治的7例隐匿性乳腺癌的临床资料进行回顾性分析。结果:本组全为女性,占同期乳腺癌的0.59%,临床症状以腋下肿块为首发症状,体查双乳均未触及明显肿块。术前行腋下肿块或细针穿刺,均找到癌细胞。本组全作乳腺钼靶X线照片,1例考虑乳腺癌可能。3例作双乳B超检查,1例考虑乳腺癌。本组5例行Halsted根治术,2例行改良根治术,术后4例在乳腺大体标本找到原发病灶,3例为浸润性导管癌,1例为导管内癌。术后2例予辅助化疗加放疗,5例予辅助化疗,4例予口服三苯氧胺治疗。本组全部随访,均仍生存,3例生存已超过2年半,最长1例生存已达7年。结论:临床上对女性腋窝肿块应高度警惕隐性乳腺癌的可能,术前予细针穿刺、腋下肿块活检(或加ER、PR检测)对帮助诊断有好处;乳腺钼靶照片和乳腺B超对乳腺原发病灶的检出率较低,多需术后乳腺大体标本病理切片确诊。治疗方法多采用乳腺癌根治术或改良根治术,术后辅以化疗、放疗等综合治疗,预后优于或相似于乳腺内有肿块且伴有腋下淋巴结转移的乳腺癌。

56例隐匿性乳腺癌临床病理特征分析及诊疗策略探讨

背景与目的:隐匿性乳腺癌发病隐匿,诊断困难,治疗策略不确定,是乳腺癌领域的难点和热点。本研究探讨了隐匿性乳腺癌的临床病理特征及诊疗策略。方法:对56例隐匿性乳腺癌患者在术前采用乳腺彩超、钼靶、磁共振及PET/CT检查,对比不同检查方法对隐匿性乳腺癌可疑原发灶检出率及病理符合率的差异。治疗方案采用新辅助化疗、乳腺癌改良根治术、保乳+腋窝淋巴结清扫术、腋窝淋巴结清扫术,术后行化疗+放疗。结果:乳腺超声、X线、MRI、PET/CT对乳腺可疑原发灶的检出率分别为7.14%(4/56)、29.41%(15/51)、37.50%(18/48)和16.28%(7/43);结合术后病理学检查发现其病理符合率分别为66.67%(2/3)、50.00%(7/14)、50.00%(9/18)和50.00%(3/6);26例患者乳腺超声、X线及MRI均未发现可疑原发灶,其中21例接受病理学检查,阳性率为14.29%(3/21);对39例乳腺癌改良根治术标本行乳腺病理切片检查,检出原发灶15例,检出率38.46%。根据St.Gallen指南分子分型标准,Luminal A型、Luminal B型、HER-2阳性型和三阴性型比例分别为7.14%、46.43%、12.50%和33.93%。术后随访52例,随访时间10~104个月,中位时间35个月,复发转移4例,死亡0例。检出原发灶的15例患者中,复发或转移2例;未检出原发灶的24例患者中,无复发或转移;行新辅助化疗17例,达病理学完全缓解(pathological complete response,PCR)2例,复发或转移2例;行乳腺癌改良根治术39例,复发或转移2例;行保乳+腋窝清扫8例,复发或转移2例;腋窝清扫9例,无复发或转移。结论:乳腺MRI检查在隐匿性乳腺癌的排除性诊断中有重要价值;乳腺超声、X线及MRI均未发现可疑原发灶的患者其乳腺病理原发灶检出率较低;隐匿性乳腺癌的治疗策略可选择新辅助化疗、乳腺癌改良根治术、保乳+腋窝清扫术、腋窝清扫术;乳腺病理学未检出原发灶的患者复发转移率低于检出原发灶者。

隐匿性乳腺癌5例临床病理分析

目的探讨隐匿性乳腺癌的临床表现、病理特征、治疗与预后。方法对5例隐匿性乳腺癌进行临床资料分析、组织形态学观察和免疫组化检测,并结合文献进行讨论。结果 5例隐匿性乳腺癌均表现为腋窝肿块,其中1例经MRI检查发现原发病灶,2例行乳腺癌改良根治术;2例行腋窝淋巴结清扫,1例行肿块扩大切除术。组织学分型:3例为浸润性导管癌,2例为混合型癌;淋巴结平均2.4枚可见转移。免疫组化示4例瘤细胞ER(+)、5例PR、CK7和E-cadherin(+),3例Her-2过表达。3例仅行腋窝肿块切除者,2例GCDFP-15(+),1例人乳腺球蛋白(+)。结论中、老年女性出现腋窝淋巴结转移性腺癌但未触及乳腺肿块时,应警惕隐匿性乳腺癌的可能。

CT对小乳癌及腋窝淋巴结转移的诊断及对手术方式选择的指导价值

目的 探讨CT扫描对小乳癌、隐匿性乳癌及腋窝淋巴结转移的诊断及对手术方式选择的指导价值。方法 采用俯卧位或仰卧位 ,扫描范围一般自乳房下界至腑窝顶 ,发现病变部位行薄层扫描 ,快速注入造影剂后测量相应层面的最高CT值。结果 CT扫描对小乳癌诊断准确性明显优于其它影像诊断方法 ,腋窝淋巴结转移的诊断假阳性及假阴性率较高。结论 CT扫描对小乳癌的诊断有一定价值。因腋窝淋巴结转移的诊断假阴性及假阳性率较高 ,对手术方式的选择仅供参考 。

隐匿型乳腺癌的临床诊治要点

隐匿型乳腺癌(Occult breast cancer,OBC)是以腋窝淋巴结转移癌为主要表现的一种少见的乳腺癌表现。对于这类患者应当进行完善的术前检查,不仅需要包括标准的双侧乳腺摄影片,还要通过超声和核磁共振评估双侧乳腺和腋窝淋巴结,以寻找原发病灶。由于此类患者具有较高的局部复发风险,因此不推荐单纯对乳腺进行观察,乳房局部治疗应包括全乳切除,也可以考虑保留乳房联合全乳放疗。同时也应进行腋窝淋巴结清扫以提高局部控制并且完善分期。此外,患者还可以接受新辅助或辅助全身治疗。虽然隐匿性乳腺癌伴腋窝转移患者的疾病分期为T_0N_(1-2)M_0期,但比同期别原发性乳腺癌预后更好,腋窝淋巴结转移数目,尤其是小于4枚转移与4枚或以上转移相比仍然是最为可靠的预测结局的因素。

动态增强MRI联合钼靶X线摄影对隐匿性乳腺癌的诊断价值

目的:探讨钼靶X线摄影与MRI联合对隐匿性乳腺癌的诊断价值。方法:回顾分析因腋窝肿块就诊,临床乳房内未触及肿块,后经腋窝肿块切除活检证实为淋巴结转移性腺癌的患者共33例,术前均行钼靶X线摄影与动态增强MRI检查。结果:MRI诊断正确30例,诊断准确率为90.91%,显示钙化4例,钙化显示率为12.12%;钼靶X线摄影诊断正确24例,诊断准确率为72.73%,显示钙化22例,钙化显示率为66.67%。两者差异均有统计学意义(P<0.01)。结论:动态增强MRI对隐匿性乳腺癌的诊断价值明显优于X线钼靶,钼靶对钙化较敏感,两者联合对早期发现、早期诊断、早期治疗隐匿性乳腺癌具有非常重要的临床意义。

MRI引导定位活检对隐匿性乳腺癌的诊治价值

目的 探讨MRI引导下定位及活检对隐匿性乳腺癌的诊治价值。方法 回顾性分析以腋窝淋巴结肿大为首发症状,仅MRI发现为可疑乳腺癌患者21例;并采用1.5T超导MRI仪扫描,通过乳腺MRI专用定位活检仪,对这些仅MRI发现的乳腺癌病灶行MRI引导活检或行MRI导丝定位引导病灶切除活检,病理学证实这些可疑病灶就是隐匿性乳腺癌原发灶。结果 MRI检测到的21例可疑病灶。病变大小4-15mm。13个病灶呈肿块样强化,病灶强化形态：呈不规则形8个,分叶形5个;病灶强化边缘：呈毛刺状4个,不规则形9个;病灶内部强化特征：8个表现为环形强化,5个表现为不均匀强化。8个病灶呈非肿块样强化。强化病灶分布：2个呈局灶强化,2个呈线样强化,4个呈导管样强化;病灶内部强化特征：全部呈不均匀混杂样强化。18例行MRI引导导丝定位病灶切除并活检,3例行MRI引导病灶穿刺活检。病理浸润型导管癌。确诊后3例行术前新辅助化疗。13例行乳腺改良根治术,8例行MRI引导导丝定位病灶切除保乳手术。结论 通过MRI引导对隐匿性病灶行精准定位或活检,能够使部分保乳手术替代乳房切除术。

隐匿性乳腺癌的诊治探讨

目的探讨隐匿性乳腺癌的临床特点及诊治方法。方法对9例隐匿性乳腺癌患者的临床资料及疗效进行回顾性分析。结果术后9例患者中6例找到乳腺癌原发灶（3~8 mm）,随访1~8年,7例行乳腺癌改良根治术的患者中5例未出现局部复发或远处转移,1例术后1年发现骨转移灶,另1例术后1.5年死于脑、肺及骨转移;2例行保乳术的患者均无局部复发或远处转移。结论对有腋窝淋巴结转移腺癌而无明显原发癌灶的女性患者,应高度警惕隐匿性乳腺癌。治疗宜采用保乳术联合腋窝淋巴结清扫术,辅以全乳腺及区域淋巴结引流区放疗、化疗、内分泌治疗以及可能的靶向治疗。

特殊类型乳腺癌动态增强MRI诊断价值

目的 评价乳腺动态增强MRI诊断特殊类型乳腺癌的价值。方法 回顾性分析 13例经手术病理证实的几种特殊类型乳腺癌的动态增强MRI表现特征。结果 6例多中心性乳腺癌、4例多灶性乳腺癌及 2例隐匿型乳腺癌具有特征性MRI表现 ,1例炎性乳腺癌病变广泛且形态多样 ,缺乏特征性。结论 乳腺动态增强MRI对多中心性、多灶性乳腺癌及隐匿型乳腺癌有重要诊断价值 。

54例隐匿性乳腺癌的临床病理特征分析

目的:分析隐匿性乳腺癌(occult breast cancer,OBC)的临床病理特征,为临床诊断和指导治疗提供更多依据。方法:回顾性分析经手术和病理证实的54例OBC患者的临床资料,并将同期45例非OBC患者作为免疫表型的对照组,研究该肿瘤的临床特点和病理生物学特性。结果:54例患者均以腋窝淋巴结肿大为主要症状。MRI临床检出率为81.3%(13/16),钼靶X线摄影临床检出率为51.9%(28/54),两者差异有统计学意义(P<0.05)。腋下淋巴结转移灶癌细胞特点多为中-低分化,表现为淋巴结弥漫浸润的、成片的、大Apocrine样细胞;免疫组化GCDFP-15、CK7、CK20和TTF-1的阳性率分别为83.3%、96.7%、6.7%和3.3%,与对照组相比差异无统计学意义(P>0.05);ER、PR的阳性率分别为46.7%和36.7%,显著低于对照组,差异有统计学意义(P<0.05)。结论:OBC以腋窝肿物为首发症状,MRI更有利于乳腺内可疑病灶的检出;OBC的ER、PR阳性率低,其确诊主要依靠术后病理和免疫组化指标。

0.1mm超微焦点放大摄影诊断隐匿性乳腺癌的价值探讨

目的:探讨0.1mm超微焦点放大摄影对隐匿性乳腺癌的诊断价值。方法:因腋窝肿块前来就诊,而临床乳房内未触及肿块,后经腋窝肿块切除活检证实为淋巴结转移性腺癌的患者共6例。6例术前均行普通钼靶X线摄影(简称普通摄影)与0.1mm超微焦点钼靶X线放大摄影(简称放大摄影),追踪随访病例仅行放大摄影。结果:普通摄影检出乳腺内癌灶2例;放大摄影检出乳腺内癌灶4例(包括普通摄影检出的2例),追踪随访2年后再检出1例,共5例。结论:放大摄影应作为检查以腋窝肿块就诊而乳房内未触及肿块的患者的常规检查方法。

免疫磁珠的制备及其在捕获乳腺癌患者白细胞中的应用

应用生物素一亲和素系统制备免疫磁珠,考察了不同条件对制备免疫磁珠的影响.结果表明：当反应温度为4℃、亲和素浓度为0.2 mg/mL、PBS pH=5.8、反应时间为2h时,磁性微球的亲和素载量为25～55 mg/g; BNHS与抗体质量比1：7时,生物素与抗体的结合率最高;亲和素与生物素化抗体摩尔比在1：3时,亲和素与生物素的偶联率最高.抗CD45免疫磁性微球的白细胞去除率高达78％,磁珠回收率达98％,可用于进一步捕获乳腺癌外周血循环肿瘤细胞.