Elastin and collagen IV double staining: A refined method to detect blood vessel invasion in breast cancer.

Blood vessel invasion (BVI) is a prognostic indicator in various cancers. Elastic stain, which highlights blood vessel walls, is commonly used to detect BVI. In the breast, however, its diagnostic usefulness is limited because it also highlights some intraductal carcinoma components, which often mimic BVI. In this study, we aimed to improve BVI detection in breast cancer and developed a double staining: Victoria blue for elastin and immunohistochemistry for collagen IV. Collagen IV fibers were retained along the basement membranes of intraductal carcinoma components, whereas they were rearranged or lost in BVI. From these observations, we defined BVI as the presence of tumor cells inside an elastic ring with a rearrangement or loss of collagen IV fibers. Using these criteria, we found BVI in 148 cases (49%) among 304 cases of primary operable invasive breast carcinoma, and the presence of BVI correlated significantly with poor prognosis. By contrast, we detected BVI in 94 cases (31%) or 14 cases (5%) by elastic van Gieson or CD31 immunostaining among the same cases, respectively, with no statistically significant association with prognosis. Thus, elastin and collagen IV double staining facilitates the detection of BVI in breast cancer and is useful to predict prognosis.

[Clinicopathological features and prognosis of synchronous bilateral breast cancers].

Objective: To study the clinicopathologic characteristics and relevant factors affecting prognosis of patients with synchronous bilateral breast cancer. Methods: The clinical data, pathologic characteristics and immunohistochemical expression characteristics of 151 patients with synchronous bilateral breast cancers diagnosed in Peking Union Medical College Hospital from 2008 to 2018 were collected and analyzed. The factors affecting the prognosis were analyzed by Log rank test, Kaplan-Meier survival analysis, Cox regression and other methods. Results: Synchronous bilateral breast cancer cases accounted for 1.2% (151/12 239) of all breast cancer patients in the same period, and 14.6% (22/151) had a family history. The patients' age range was 22-88 years, mainly female, with a mean survival of 42.5 months. There were 106 patients with synchronous bilateral invasive breast cancers, 6 patients with synchronous bilateral breast cancer in situ, and 39 patients with unilateral invasive breast cancer and unilateral breast cancer in situ. In synchronous bilateral invasive breast cancers, the histological type was mainly non-specific type (84.9%, 180/212), the histological grade was mainly Grade 2 (60.8%,129/212), the TNM stage was mainly stage Ⅰ (50.5%, 107/212), the tumor size was mainly T1 (68.9%, 146/212), and the regional lymph node was mainly N0 (61.8%, 131/212). The molecular subtypes were mainly Luminal A-like (38.1%, 75/197) and Luminal B-like (43.7%, 86/197); ER (78.2%, 154/197) and PR (72.1%,142/197)were mainly positive, and HER2 was mainly negative (91.9%, 181/197). There were 85 (80.2%) patients and 75 (70.8%) patients with the same histological type and histological grade on both sides, respectively. The concordance of tumor size T stage and the regional lymph nodes N stage were 58.5% (62/106) and 55.7% (59/106), respectively. The concordance of molecular subtype was 54.9% (50/91), and the concordance of ER, PR, HER2 and Ki-67 were 83.5% (76/91), 76.9% (70/91), 89.0% (81/91) and 59.3% (54/91), respectively. The expression of ER and PR in synchronous bilateral invasive breast cancer was significantly correlated with prognosis (P<0.05). Conclusions: Among patients with synchronous bilateral breast cancers, bilateral invasive breast cancer is the most common, the prognosis is the worst, and the pathologic characteristics of bilateral breast cancer tend to be consistent. The expression of ER and PR in synchronous bilateral invasive breast cancer is significantly correlated with prognosis, that is, best for bilateral ER-positive patients, worst for bilateral ER-negative patients, and intermediate for unilateral ER-positive patients, thus suggesting the importance of ER and PR detection in synchronous bilateral invasive breast cancers.

[Effects of ubiquitin-specific proteases 2-69 on proliferation of breast cancer cells].

Objective: To investigate the expression and significance of ubiquitin-specific proteases 2-69(USP2-69) in invasive ductal carcinoma of breast. Methods: Twenty-four cases of human breast tissue with invasive ductal carcinoma diagnosed at Huanshan Hospital, Fudan University from 2013 to 2015 were collected, and the expression of USP2-69 mRNA and protein was detected by molecular hybridization, Western blot and immunohistochemistry. USP2-69 was over-expressed in cultured human breast cancer cell line MCF-7 by USP2-69 plasmid transfection. The cellular proliferative activity was investigated in vitro. Results: The USP2-69 mRNA and protein were highly expressed in breast invasive ductal carcinoma, compared to adjacent normal tissues (P<0.01). Ki-67 protein expression was also increased in cases with high USP2-69 protein level. Western blot showed significantly higher USP2-69 protein level in cancer tissue compared to the adjacent normal tissue. In the cultured tumor cells, there was increased S phase fraction, cellular proliferation rate, flat positive clones, cyclin D1 expression and decreased p27 expression in USP2-69-transfected MCF-7 cells. Conclusions: USP2-69 is over-expressed in breast invasive ductal carcinoma, and is closely related to proliferation promoting effects. The data provide an important experimental basis for further study on the molecular mechanism of breast cancer cell proliferation.

Suspicious breast calcifications undergoing stereotactic biopsy in women ages 70 and over: Breast cancer incidence by BI-RADS descriptors.

OBJECTIVES: To determine the malignancy rate overall and for specific BI-RADS descriptors in women ≥70 years who undergo stereotactic biopsy for calcifications. METHODS: We retrospectively reviewed 14,577 consecutive mammogram reports in 6839 women ≥70 years to collect 231 stereotactic biopsies of calcifications in 215 women. Cases with missing images or histopathology and calcifications associated with masses, distortion, or asymmetries were excluded. Three breast radiologists determined BI-RADS descriptors by majority. Histology, hormone receptor status, and lymph node status were correlated with BI-RADS descriptors. RESULTS: There were 131 (57 %) benign, 22 (10 %) atypia/lobular carcinomas in situ, 55 (24 %) ductal carcinomas in situ (DCIS), and 23 (10 %) invasive diagnoses. Twenty-seven (51 %) DCIS cases were high-grade. Five (22 %) invasive cases were high-grade, two (9 %) were triple-negative, and three (12 %) were node-positive. Malignancy was found in 49 % (50/103) of fine pleomorphic, 50 % (14/28) of fine linear, 25 % (10/40) of amorphous, 20 % (3/15) of round, 3 % (1/36) of coarse heterogeneous, and 0 % (0/9) of dystrophic calcifications. CONCLUSIONS: Among women ≥70 years that underwent stereotactic biopsy for calcifications only, we observed a high rate of malignancy. Additionally, coarse heterogeneous calcifications may warrant a probable benign designation. KEY POINTS: • Cancer rates of biopsied calcifications in women ≥70 years are high • Radiologists should not dismiss suspicious calcifications in older women • Coarse heterogeneous calcifications may warrant a probable benign designation.

Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ.

OBJECTIVES: To investigate whether mass stiffness measured by shear-wave elastography (SWE) can predict the histological upgrade of ductal carcinoma in situ (DCIS) confirmed through ultrasound (US)-guided core needle biopsy (CNB). METHODS: The institutional review board approved this study and informed consent was waived. A database search revealed 120 biopsy-confirmed DCIS in patients who underwent B-mode US and SWE prior to surgery. Clinicopathologic results, B-mode findings, size on US, and mean and maximum elasticity values on SWE were recorded. Associations between upgrade to invasive cancer and B-mode US findings, SWE information, and clinical variables were assessed using univariate, multivariate logistic regression, and multiple linear regression analysis. RESULTS: The overall upgrade rate was 41.7 % (50/120). Mean stiffness value (P = .014) and mass size (P = .001) were significantly correlated with histological upgrade. The optimal cut-off value of mean stiffness value, yielding the maximal sum of sensitivity and specificity, was 70.7 kPa showing sensitivity of 72 % and specificity of 65.7 % for detecting invasiveness. Qualitative elasticity colour scores were significantly correlated with the histological upgrade, mammographic density, and B-mode category (P < .04). CONCLUSION: Mean stiffness values evaluated through SWE can be utilized as a preoperative predictor of histological upgrade to invasive cancer in DCIS confirmed at US-guided needle biopsy. KEY POINTS: • Higher stiffness values were noted in invasive cancer than DCIS. • Qualitative SWE colour scores significantly correlated with the histological upgrade. • Qualitative SWE colour scores had excellent interobserver agreement.

[Ki-67 expression and its effect on response to neo-adjuvant chemotherapy in invasive breast cancer].

Objective: To investigate the response to neoadjuvant chemotherapy (NAC) among different molecular subtypes of breast cancers using molecular classification with Ki-67 (ER+ PR+ HER2+ Ki-67) or without Ki-67 (ER+ PR+ HER2). Methods: One hundred and twenty-seven cases of invasive breast cancer confirmed by core needle biopsy before NAC were collected from January 2007 to December 2009 and diagnosed at West China Hospital, Sichuan University. The cases were classified into different molecular subtypes using molecular classifications with or without Ki-67. Their clinical and pathological response to NAC was evaluated and compared. Results: The different subtypes using both molecular classifications showed significant difference in clinical response(with Ki-67: χ(2)=22.40, P<0.01; without Ki-67: χ(2)=9.202, P=0.027)but not pathological(P>0.05) response to NAC. By multivariate analysis, Ki-67 was predictive for a clinical complete response (P=0.041) and clinical overall response (P<0.01); also Ki-67 was the only clinicopathological factor predictive of pathological response(P=0.041). Conclusion: The molecular classification with Ki-67 is better to predict breast cancers responsiveness to NAC than the molecular classification without Ki-67.

Initial Fludeoxyglucose (18F) Positron Emission Tomography-Computed Tomography (FDG-PET/CT) Imaging of Breast Cancer - Correlations with the Primary Tumour and Locoregional Metastases.

BACKROUND: We aimed to evaluate initial PET/CT features of primary tumour and locoregional metastatic lymph nodes (LNs) in breast cancer and to look for potential relationships between several parameters from PET/CT. MATERIAL/METHODS: Twenty-three women (mean age; 48.66±12.23 years) with a diagnosis of primary invasive ductal carcinoma were included. They underwent PET/CT imaging for the initial tumour staging and had no evidence of distant metastates. Patients were divided into two groups. The LABC (locally advanced breast cancer) group included 17 patients with ipsilateral axillary lymph node (LN) metastases. The Non-LABC group consisted of six patients without LN metastases. PET/CT parameters including tumour size, axillary LN size, SUVmax of ipsilateral axillary LNs (SUVmax-LN), SUVmax of primary tumour (SUVmax-T) and NT ratios (SUVmax-LN/SUVmax-T) were compared between the groups. Correlations between the above-mentioned PET/CT parameters in the LABC group as well as the correlation between tumour size and SUVmax-T within each group were evaluated statistically. RESULTS: The mean values of the initial PET/CT parameters in the LABC group were significantly higher than those of the non-LABC group (p<0.05). The correlation between tumour size and SUVmax-T value within both LABC and non-LABC groups was statistically significant (p<0.05). In the LABC group, the correlations between the size and SUVmax-LN values of metastatic axillary LNs, between tumour size and metastatic axillary LN size, between SUVmax-T values and metastatic axillary LN size, between SUVmax-T and SUVmax-LN values, and between tumour size and SUVmax-LN values were all significant (p<0.05). CONCLUSIONS: We found significant correlations between PET/CT parameters of the primary tumour and those of metastatic axillary LNs. Patients with LN metastases had relatively larger primary tumours and higher SUVmax values.

Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?

OBJECTIVES: To assess MRI-pathology concordance and factors influencing tumour size measurement in breast cancer. MATERIALS AND METHODS: MRI tumour size (greatest diameter in anatomical planes (MRI-In-Plane) and greatest diameter along main tumour axis (MRI-MPR)) of 115 consecutive breast lesions (59 invasive lobular carcinoma, 46 invasive ductal carcinoma, and 10 ductal carcinoma in situ) was retrospectively compared to size measured at histopathology (pT size (Path-TNM) and greatest tumour diameter as relevant for excision (Path-Diameter; reference standard)). Histopathological tumour types, preoperative palpability, surgical management, additional high-risk lesions, and BI-RADS lesion type (mass versus non-mass enhancements) were assessed as possible influencing factors. RESULTS: Systematic errors were most pronounced between MRI-MPR and Path-TNM (7.1 mm, limits of agreement (LoA) [-21.7; 35.9]), and were lowest between MRI-In-Plane and Path-Diameter (0.2 mm, LoA [-19.7; 20.1]). Concordance rate of MRI-In-Plane with Path-Diameter was 86% (97/113), overestimation 9% (10/113) and underestimation 5% (6/113); BI-RADS mass lesions were overestimated in 7% (6/81) versus 41% (13/32) for non-mass enhancements. On multivariate analysis only BI-RADS lesion type significantly influenced MRI-pathology concordance (p < 0.001). 2/59 (3%) ILC did not enhance. CONCLUSION: Concordance rate varies according to the execution of MRI and histopathological measurements. Beyond this only non-mass enhancement significantly predicted discordance. KEY POINTS: • Execution and scope of MRI and histopathological size measurements influence concordance rate. • Non-mass like enhancement predicts discordance. • Additional high-risk lesions in proximity of tumour do not cause measurement discordance. • Low percentage of ILC do not enhance at all.

Sonographically Unusual Breast Carcinomas, 2 Case Reports.

BACKGROUND: For infiltrative breast lesions; sonography might not always be as helpful as mammography and MRI (magnetic resonance imaging). For higher sensitivity and specificity, these 3 imaging methods should be carried out together. Radiologists should be aware of the patient's history and complaints. Patients who have a specific history like a long-term drug treatment or a palpable tumour should be approached differently. CASE REPORT: We would like to present 2 cases with atypical sonographic findings. The first case is an infiltrative breast cancer with occult sonography findings in a patient with a history of a long-term immunosuppressive drug treatment due to kidney transplantation and the second case is a malignant breast tumour which is hyperechogenic on sonography. CONCLUSIONS: Overall breast sonography should always be correlated with mammography in patients over 40 years old and the images should be interpreted along with the patient's history and clinical status.

Intravenous Immunoglobulin to Suppress Progression in a Patient With Advanced Breast Cancer.

Intravenous immunoglobulin (IVIG) is used to treat various diseases and has anticancer effects that suppress metastases in animal models of sarcoma and melanoma. However, these effects have been observed in a limited number of clinical cases. We report the case of a patient with metastatic breast cancer in which long-term IVIG treatment stopped disease progression in the absence of salvage chemotherapy. The patient was treated with IVIG for the treatment of immune thrombocytopenia. Surprisingly, the lung and brain metastases were stabilized, and the patient achieved a progression-free interval of 29 months. More cases are needed to investigate and confirm the efficacy of IVIG in solid tumors in the future.

Metaplastic breast carcinoma with extensive osseous differentiation.

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.

Imaging Features of Patients Undergoing Active Surveillance for Ductal Carcinoma in Situ.

RATIONALE AND OBJECTIVES: The aim of this study was to describe the imaging appearance of patients undergoing active surveillance for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: We retrospectively identified 29 patients undergoing active surveillance for DCIS from 2009 to 2014. Twenty-two patients (group 1) refused surgery or were not surgical candidates. Seven patients (group 2) enrolled in a trial of letrozole and deferred surgical excision for 6-12 months. Pathology and imaging results at the initial biopsy and follow-up were recorded. RESULTS: In group 1, the median follow-up was 2.7 years (range: 0.6-13.9 years). Fifteen patients (68%) remained stable. Seven patients (32%) underwent additional biopsies with invasive ductal carcinoma diagnosed in two patients after 3.9 and 3.6 years who developed increasing calcifications and new masses. In group 2, one patient (14%) was upstaged to microinvasive ductal carcinoma at surgery. Among the patients in both groups with calcifications (n = 26), there was no progression to invasive disease among those with stable (50%, 13/26) or decreased (19%, 5/26) calcifications. CONCLUSIONS: Among a DCIS active surveillance cohort, invasive disease progression presented as increasing calcifications and a new mass following more than 3.5 years of stable imaging. In contrast, there was no progression to invasive disease among cases of DCIS with stable or decreasing calcifications. Close imaging is a key follow-up component in active surveillance.

A Potential Additional Variable to Consider in the Surgical Treatment of Ductal Carcinoma in Situ.

BACKGROUND: HER2/neu is a potentially interesting variable that has been demonstrated to have a profound impact on the management of invasive breast carcinoma, and we performed this study to evaluate the differences between HER2-positive and HER2-negative ductal carcinoma in situ. The impetus for this study was our poor recruitment to the National Surgical Adjuvant Breast and Bowel Project Protocol B-43 trial that was designed to evaluate the potential role of trastuzumab in breast conservation therapy for patients with HER2-positive ductal carcinoma in situ. METHODS: All patients with ductal carcinoma in situ and an assessment for the HER2/neu receptor were identified. Patients with HER2-positive and HER2-negative ductal carcinoma in situ were compared to determine differences in demographic, hormone receptor status, nuclear grade, presence of necrosis, surgical procedure (lumpectomy or mastectomy), tumor size, and extent of margins. Quantitative variables were analyzed with t test, and nominal variables were assessed by chi square analysis. RESULTS: A total of 177 patients were identified with a mean age of 61.0 years. A total of 101 patients (57.1%) were treated with lumpectomy, and 76 had mastectomy (42.9%). Forty-four (24.9%) patients were positive, and 133 (75.1%) were negative for the HER2/neu receptor. HER2-positive tumors were larger (23.6 vs 13.8 mm, P=0.001) and more likely to undergo mastectomy (61.4% vs 36.8%, P=0.01). CONCLUSION: Based on these results, an HER2-positive ductal carcinoma in situ is likely to be larger than an HER2-negative tumor, leading to more frequent use of mastectomy. This finding would explain our poor recruitment to the National Surgical Adjuvant Breast and Bowel Project Protocol B-43 trial.

HistoBCAD: herramienta de código abierto para detección de cáncer de mama en imágenes histopatológicas

RESUMEN Fundamento: la detección y clasificación precisa del cáncer de mama mediante el diagnóstico histopatológico es de vital importancia para el tratamiento efectivo de la enfermedad. Entre los tipos de cáncer de mama, el carcinoma ductal invasivo es el más frecuente. El análisis visual de las muestras de tejido en el microscopio es un proceso manual que consume tiempo y depende del observador. Sin embargo, en muchos países, incluido Cuba, es escaso el uso de herramientas software para asistir el diagnóstico. Objetivo: desarrollar una herramienta software para detectar tejido de cáncer de mama, del subtipo carcinoma ductal invasivo, en imágenes histopatológicas. Métodos: la herramienta se implementó en Python e incluye métodos de detección de carcinoma ductal invasivo en imágenes histopatológicas, basados en algoritmos de extracción de características de color y textura en combinación con un clasificador de bosques aleatorios. Resultados: la herramienta de código abierto brinda una serie de facilidades para la lectura, escritura y visualización de imágenes histopatológicas, delineación automática y manual de zonas cancerígenas, gestión de los datos diagnósticos del paciente y evaluación colaborativa a distancia. Fue evaluada en una base de datos con 162 imágenes de pacientes diagnosticados con carcinoma ductal invasivo y se obtuvo una exactitud balanceada de 84 % y factor F1 de 75 %. Conclusiones: la herramienta permitió un análisis interactivo, rápido, reproducible y colaborativo mediante una interfaz gráfica sencilla e intuitiva. En versiones futuras se prevé incluir nuevos métodos de aprendizaje automático incremental para el análisis de imágenes histopatológicas digitales.

ABSTRACT Background: the accurate detection and classification of breast cancer through histopathological diagnosis is of vital importance for the effective treatment of the disease. Among the types of breast cancer, invasive ductal carcinoma (IDC) is the most common. Visual analysis of tissue samples under the microscope is a manual, time-consuming and observer-dependent process. However, in many countries, including Cuba, the use of software tools to assist diagnosis is scarce. Objective: to develop a software tool to detect IDC subtype breast cancer tissue in histopathological images. Methods: the tool is implemented in Python and includes IDC detection methods in histopathological images, based on algorithms for extraction of color and texture features in combination with a random forest classifier. Results: the open source tool provides a series of facilities for the reading, writing and visualization of histopathological images, automatic and manual delineation of cancer areas, management of patient diagnostic data and collaborative remote evaluation. It was evaluated in a database with 162 images of patients diagnosed with IDC, obtaining a balanced accuracy of 84 % and a F1 factor of 75 %. Conclusions: the tool allowed an interactive, fast, reproducible, precise and collaborative analysis through a simple and intuitive graphical interface. Future versions are expected to include new incremental machine learning methods for the analysis of digital histopathology images.

Metaplastic breast carcinoma with extensive osseous differentiation

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.

Câncer de Mama Multifocal: Relato de Caso / Multifocal Breast Cancer: Case Report / Cáncer de Mama Multifocal: Relato de caso

Introdução: O câncer de mama é a neoplasia que mais acomete o sexo feminino, sendo a primeira causa de morte por câncer em mulheres.O carcinoma mamário representa um grupo heterogêneo de doenças. Casos individuais diferem uns dos outros na morfologia, fenótipo e prognóstico. As patologias malignas das mamas podem se manifestar como tumores unifocais, multifocais e/ou multicêntricos. A incidência de tumores multifocais e multicêntricos no câncer de mama varia de 13% a 70%. Relato do caso: Paciente L.C., sexo feminino, 65 anos, com relato de nódulo palpável em mama direita em setembro de 2015. O estudo anatomopatológicodo nódulo mostrou carcinoma intraductal. Realizada quadrantectomia, com anatomopatológico que identificou carcinoma papilífero bem diferenciado intracístico e invasivo damama, associado a componente intraductal cribriforme e papilar, com margens e linfonodo sentinela livres e imuno-histoquímica compatível com perfil triplo-negativo. Em fevereiro de 2019, apresentou duas novas lesões em mama contralateral, identificadas como carcinoma ductal invasivo multifocal com papiloma intraductal associado, e carcinoma ductal invasivo associado a componente intraductal in situ dos tipos papilar, sólido e cribriforme, com imuno-histoquímica com perfis moleculares distintos entre si, sendo uma lesão do tipo luminal A e a outra, luminal híbrido. Conclusão: Este estudo relata um caso de uma paciente que apresentou lesões neoplásicas em ambas as mamas, em tempos distintos e com perfis histológicos e imuno-histoquímicos diferentes. Dessa forma, destacam-se a raridade do caso e a relevância da terapia dirigida a alvos específicos, uma vez que a paciente apresentava lesões com perfis moleculares distintos.

Introduction: Breast cancer is the neoplasm that most affects females, being the first cause of death by cancer in women. Breast carcinoma is a heterogeneous group of diseases. Individual cases differ from each other in morphology, phenotype and prognosis. Malignant breast pathologies can manifest as single, multifocal and/or multicentric tumors. The incidence of multifocal and multicentric tumors in breast cancer varies from 13% to 70%. Case report: Patient L.C., female, 65 years old, with a palpable nodule in the right breast in September 2015. The anatomopathological study of the nodule showed intraductal carcinoma. She underwent quadrantectomy, with anatomopathological examination that identified well-differentiated intracystic and invasive papillary carcinoma of the breast, associated with a cribriform and papillary intraductal component, with free sentinel lymph node and margins and immunohistochemistry compatible with triple negative profile. In February 2019, she presented two new lesions in contralateral breast, identified as invasive multifocal ductal carcinoma, with associated intraductal papilloma, and invasive ductal carcinoma, associated with an in situ intraductal component of the papillary, solid and cribriform types, with immunohistochemistry with different molecular profiles, being one lesion classified as luminal A and the other, hybrid luminal. Conclusion: This study reports a case of a patient who had neoplastic lesions in both breasts, at different times and with distinctive histological and immunohistochemical profiles. Thus, the rarity of the case and the relevance of the therapy aimed at specific targets are highlighted, since the patient presented lesions with different molecular profiles.

Introducción: El cáncer de mama es la neoplasia que más afecta a las mujeres, siendo la primera causa de muerte por cáncer en las mujeres. El carcinoma de mama representa un grupo heterogéneo de enfermedades. Los casos individuales difieren entre sí en morfología, fenotipo y pronóstico. Las patologías mamarias malignas pueden manifestarse como tumores únicos, multifocales y/o multicéntricos. La incidencia de tumores multifocales y multicéntricos en el cáncer de mama varía del 13% al 70%. Relato del caso: Paciente L.C., mujer, 65 años, con un nódulo palpable en el seno derecho en septiembre de 2015. El estudio anatomopatológico de la lesión mostró carcinoma intraductal. La paciente se sometió a una cuadrantectomía, con un examen anatomopatológico que identificó un carcinoma papilar invasivo e intraquístico bien diferenciado de mama, asociado con un componente intraductal cribiforme y papilar, con ganglio linfático y márgens libres y inmunohistoquímica compatible con perfil triple negativo. En febrero de 2019, presentó dos nuevas lesiones en el seno contralateral, identificadas como carcinoma ductal multifocal invasivo, con papiloma intraductal asociado y carcinoma ductal invasivo, asociado con un componente intraductal in situ de los tipos papilar, sólido y cribiforme, con inmunohistoquímica con diferentes perfiles moleculares, siendo una lesión del tipo luminal A y la otra, luminal híbrida. Conclusión: Este estudio reporta un caso de una paciente que tenía lesiones neoplásicas en ambos senos, en diferentes momentos y con diferentes perfiles histológicos e inmunohistoquímicos. Por lo tanto, se destaca la rareza del caso y la relevancia de la terapia dirigida a objetivos específicos, una vez que la paciente presentó lesiones con diferentes perfiles moleculares.

Solitary pancreatic metastasis from breast cancer: case report and review of literature

ABSTRACT CONTEXT: Pancreatic metastases from primary malignant tumors at other sites are rare, constituting about 2% of the neoplasms that affect the pancreas. Pancreatic metastasis from breast cancer is extremely rare and difficult to diagnose, because its clinical and radiological presentation is similar to that of a primary pancreatic tumor. CASE REPORT: A 64-year-old female developed a lesion in the pancreatic tail 24 months after neoadjuvant therapy, surgery and adjuvant radiation therapy for right-side breast cancer (ductal carcinoma). She underwent distal pancreatectomy with splenectomy and left adrenalectomy, and presented an uneventful outcome. The immunohistochemical analysis on the surgical specimen suggested that the lesion originated from the breast. CONCLUSION: In cases of pancreatic lesions detected in patients with a previous history of breast neoplasm, the possibility of pancreatic metastasis should be carefully considered.

EVALUATION OF LOCAL RECURRENCE OF BREAST CONSERVATION SURGERY AT THE CEARÁ INSTITUTE OF CANCER / Avaliação da recidiva local da cirurgia conservadora de mama no Instituto do Câncer do Ceará

Introduction: Breast cancer is the most common malignant tumor in the world, with the exception of cases of non-melanoma skin cancer. In Brazil, more than 56,000 cases were estimated for 2016. The expected mortality rate remains high because of late diagnosis. Nowadays, conservative surgery is the gold standard treatment. Objective: To evaluate the locoregional recurrence of conservative surgery practiced at the Ceará Institute of Cancer, between 2002 and 2012. Method: A cross ­ sectional study with a descriptive approach using secondary data obtained from the medical records of patients with breast cancer operated at the Ceará Institute of Cancer. Results: The study population consisted of 360 patients. Invasive ductal carcinoma was the most common type (72.8%), followed by ductal carcinoma in situ (16.4%) and invasive lobular carcinoma (4.7%). The other histological types represent 6.4% (cribriform, 0.5%, medullary, 0.6%, micro invasive, 0.3%, mucinous, 1.1%, papillary, 3.1% 8%; and tubular, 0.8%). In the sample, 25 patients had some type of recurrence: 13/360 (3.6%), local or locoregional; and 12/360 (3.3%), distant recurrence. Conclusion: From the data analysis, we can conclude that the conservative surgery practiced at the Ceará Institute of Cancer showed data on recurrence compatible with the international literature

Introdução: O câncer de mama é o tumor maligno que mais acomete mulheres em todo o mundo, excetuando-se os casos de pele não melanoma. No Brasil, estimavam-se mais de 56.000 casos para 2016. A mortalidade esperada ainda é alta devido ao diagnóstico tardio. Na atualidade, a cirurgia conservadora é o padrão-ouro. Objetivo: Avaliar a recidiva locorregional da cirurgia conservadora praticada no Instituto do Câncer do Ceará, no período entre 2002 a 2012. Método: Estudo transversal e descritivo, utilizando dados secundários obtidos nos prontuários médicos de pacientes com câncer de mama operadas no Instituto do Câncer do Ceará. Resultados: A população em estudo foi de 360 pacientes. O carcinoma ductal invasivo foi o tipo mais comum (72,8%), seguido do carcinoma ductal in situ (16,4%) e do carcinoma lobular invasivo (4,7%). Os outros tipos histológicos representam 6,4% (cribiforme, 0,5%; medular, 0,6%; microinvasor, 0,3%; mucinosos, 1,1%; papilífero, 3,1%; e tubular, 0,8%). Na amostra, 25 pacientes tiveram algum tipo de recidiva: 13/360 (3,6%), local ou locorregional; e 12/360 (3,3%), recidiva a distância. Conclusão: Da análise dos dados, podemos concluir que a cirurgia conservadora praticada no Instituto do Câncer do Ceará tem dados de recorrência compatíveis com a literatura internacional

Palpable ductal carcinoma in situ of the breast.

BACKGROUND: Male breast cancer is relatively rare, comprising only 0.7% of all breast cancer cases. Male breast cancer usually presents with a palpable, nontender, retroareolar mass and occasional bloody discharge from the nipple. The typical age at presentation is between 60 and 70 years old (mean age of 67), which is significantly later than female presentation. Male breast cancer is generally diagnosed at a more advanced stage than female breast cancer. CASE REPORT: A 74-year-old white male presented to his primary care physician with a palpable, nontender 2.5 cm mass in the subareolar region of his right breast. The patient underwent a right mastectomy with right sentinel lymph node biopsy. The final surgical pathology revealed a 20 mm area of stage 0 intracystic papillary-type ductal carcinoma in situ. CONCLUSION: Male breast cancer is a relatively rare cause of morbidity and mortality among men. Screening for male breast cancer is not recommended for the general population but is encouraged for individuals known to be high risk. High-risk status is reserved for patients with extensive family history of breast cancer, known BRCA2 mutations, medical disorders causing hyperestrogenism, or radiation exposure.