RESUMO
RATIONALE: Salivary duct carcinoma (SDC) is an aggressive form of cancer, with cutaneous metastasis being a rare occurrence. Furthermore, cutaneous metastasis of SDC secondary to a scald is even rarer, and to the best of our knowledge, our case represents the first such instance. Considering the involvement of the fingers in the metastatic site, which may affect limb function and quality of life, we present this case to explore the reason why scald could lead to distant recurrence and better treatment options. PATIENT CONCERNS: An 85-year-old man diagnosed with SDC in the parotid gland found enlarged masses at the fingertips as a consequence of a burn, 6 years after his initial treatment. DIAGNOSES: Cutaneous metastasis of SDC in the parotid gland and left thumb loss due to surgery. INTERVENTIONS: Radiotherapy was offered, targeting at the masses on the fingers, with dose at 15 Gy in 3 fractions, 12 Gy in 3 fractions, 15 Gy in 3 fractions for both hands and additional 21 Gy in 7 fractions only for left hand. OUTCOMES: The tumors shrank after 2 months of radiotherapy and the patient recovered well. Side effects included nail hyperplasia and paronychia. LESSONS: Connections between scald and distant metastasis of malignant tumors in this case needed further investigation. Considering reserving function of the fingers while dealing with metastasis, radiotherapy is recommended rather than surgery.
Assuntos
Dedos , Neoplasias Cutâneas , Idoso de 80 Anos ou mais , Humanos , Masculino , Carcinoma Ductal/secundário , Carcinoma Ductal/patologia , Carcinoma Ductal/terapia , Dedos/patologia , Neoplasias Parotídeas/patologia , Ductos Salivares/patologia , Neoplasias das Glândulas Salivares/patologia , Neoplasias Cutâneas/secundário , Neoplasias Cutâneas/patologiaRESUMO
The 42-year-old patient, diagnosed with Stage IIA breast cancer, completed the postoperative adjuvant chemotherapy and radiotherapy. At the 11th year of diagnosis, a 3 cm tumor was detected in the pancreas and pancreatectomy was performed. Although the diagnosis of primary pancreatic adenocarcinoma was made at first, then the pancreatic metastasis of breast cancer was discovered. Pancreatic metastasis of breast cancer is extremely rare, and a limited number of patients have been reported in the literature. Here, we report an additional case of this rare tumor and the problems correlating with its diagnosis.
Assuntos
Neoplasias da Mama/secundário , Carcinoma Ductal/secundário , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/diagnóstico , Adulto , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal/complicações , Carcinoma Ductal/diagnóstico , Carcinoma Ductal/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Humanos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Neoplasias PancreáticasRESUMO
BACKGROUND: Ductal adenocarcinoma is an uncommon prostate cancer variant. Previous studies suggest that ductal variant histology may be associated with worse clinical outcomes, but these are difficult to interpret. To address this, we performed an international, multi-institutional study to describe the characteristics of ductal adenocarcinoma, particularly focussing on the effect of presence of ductal variant cancer on metastasis-free survival. METHODS: Patients with ductal variant histology from two institutional databases who underwent radical prostatectomies were identified and compared with an independent acinar adenocarcinoma cohort. After propensity score matching, the effect of the presence of ductal adenocarcinoma on time to biochemical recurrence, initiation of salvage therapy and the development of metastatic disease was determined. Deep whole-exome sequencing was performed for selected cases (n = 8). RESULTS: A total of 202 ductal adenocarcinoma and 2037 acinar adenocarcinoma cases were analysed. Survival analysis after matching demonstrated that patients with ductal variant histology had shorter salvage-free survival (8.1 versus 22.0 months, p = 0.03) and metastasis-free survival (6.7 versus 78.6 months, p < 0.0001). Ductal variant histology was consistently associated with RB1 loss, as well as copy number gains in TAP1, SLC4A2 and EHHADH. CONCLUSIONS: The presence of any ductal variant adenocarcinoma at the time of prostatectomy portends a worse clinical outcome than pure acinar cancers, with significantly shorter times to initiation of salvage therapies and the onset of metastatic disease. These features appear to be driven by uncoupling of chromosomal duplication from cell division, resulting in widespread copy number aberration with specific gain of genes implicated in treatment resistance.
Assuntos
Adenocarcinoma/mortalidade , Carcinoma Ductal/mortalidade , Prostatectomia/mortalidade , Neoplasias da Próstata/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Carcinoma Ductal/secundário , Carcinoma Ductal/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
ABSTRACT: Bone metastasis seriously affects the survival of breast cancer. Therefore, the study aimed to explore the independent prognostic factors in bone metastatic breast cancer (BMBC) and to construct a prognostic nomogram that can accurately predict the survival of BMBC and strictly divide the patients into different risk stratification.Four thousand three hundred seventy six patients with BMBC from the surveillance, epidemiology, and end results database in 2010 to 2015 were collected and randomly divided into training and validation cohort. Multivariate Cox regression identified the independent prognostic factors of BMBC. A nomogram for predicting cancer-specific survival (CSS) in BMBC was created using R software. The predictive performance of the nomogram was evaluated by plotting receiver operating characteristic (ROC) curves and calibration curves.Marital status, race, age, T stage, tumor grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, brain metastasis, liver metastasis, lung metastasis, chemotherapy, and breast surgery were identified as independent prognostic factors for CSS of BMBC. The area under the ROC curve at 1-, 3-, and 5-year of the nomogram were 0.775, 0.756, and 0.717 in the internal validation and 0.785, 0.737, and 0.735 in the external validation, respectively. Calibration curves further confirmed the unbiased prediction of the model. Kaplan-Meier analysis verified the excellent risk stratification of our model.The first prognostic nomogram for BMBC constructed in our study can accurately predict the survival of BMBC, which may provide a practical tool to help clinicians evaluate prognosis and stratify the prognostic risk for BMBC, thereby determining which patients should be given intensive treatment and optimizing individual treatment strategies for BMBC.
Assuntos
Neoplasias Ósseas/secundário , Neoplasias da Mama/mortalidade , Carcinoma Ductal/secundário , Nomogramas , Idoso , Neoplasias Ósseas/mortalidade , Osso e Ossos/patologia , Neoplasias da Mama/patologia , Carcinoma Ductal/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Programa de SEER , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To describe the clinical, therapeutic and prognostic features of ductal carcinomas of the parotid gland. MATERIAL AND METHODS: Five patients with ductal carcinoma of the parotid gland (primary and secondary carcinoma) treated, between 2007 and 2019, in our ENT department, were reviewed. RESULTS: Four men and one woman were included. The mean age was 61,4 years. One patient had a history of an invasive ductal carcinoma of the breast. Four patients consulted for swelling in the parotid region. One patient referred to our department for dysfunction of facial nerve. Skin invasion was found in one case. Four patients underwent total parotidectomy with sacrifice of the facial nerve (three cases). One patient underwent extended parotidectomy involving the skin. An ipsilateral selective neck dissection was performed in four cases. One patient had a parotid gland biopsy. Ductal carcinoma was primary in four cases and metastatic from breast origin in one case. Four patients were treated with postoperative radiotherapy. Remission was obtained in three cases. One patient had a local and meningeal recurrence. The patient with metastatic carcinoma had pulmonary, bone, hepatic and brain progression. CONCLUSION: Ductal carcinoma is a rare and aggressive tumor of the parotid gland. It can be primary or secondary. The treatment is based on surgery and radiotherapy. The prognosis is poor.
Assuntos
Carcinoma Ductal/cirurgia , Neoplasias Parotídeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma Ductal/diagnóstico por imagem , Carcinoma Ductal/patologia , Carcinoma Ductal/secundário , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/secundário , Nervo Facial/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/estatística & dados numéricos , Invasividade Neoplásica , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/cirurgia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/secundário , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/patologiaAssuntos
Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/secundário , Neoplasias da Mama/patologia , Carcinoma Ductal/tratamento farmacológico , Carcinoma Ductal/secundário , Furanos/uso terapêutico , Cetonas/uso terapêutico , Radioterapia/métodos , Barreira Hematoencefálica/metabolismo , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Carcinoma Ductal/diagnóstico por imagem , Carcinoma Ductal/radioterapia , Terapia Combinada , Feminino , Furanos/metabolismo , Humanos , Cetonas/metabolismo , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Eccrine carcinoma involvement of the central nervous system (CNS) is exceedingly rare. The prognosis and response to treatment of this pathology remain poorly characterized. METHODS: A retrospective case series and literature review were conducted. RESULTS: CNS-invading eccrine carcinoma was diagnosed in 3 patients (2 male and 1 female; age range, 60-79 years), including 2 cases of brain metastases and 1 case of brain-invading skull metastasis with subsequent spinal metastasis. The interval from primary tumor to CNS invasion was 18-51 months. All patients received multimodal therapy following diagnosis of CNS involvement. One patient who harbored a NOTCH1 mutation demonstrated a durable oncologic response after treatment with the immune checkpoint inhibitor pembrolizumab and lived 39 months after CNS invasion. The other 2 patients were discharged to hospice care within 1 month after the diagnosis of eccrine carcinoma brain metastasis. Including this case series, 23 cases of eccrine carcinoma invasion or metastasis to the CNS have been reported, with survival after diagnosis of CNS involvement ranging from a few weeks to 4 years. CONCLUSIONS: We present 3 cases of eccrine carcinoma metastatic to the CNS, including the first reported case to our knowledge of eccrine carcinoma treated with immunotherapy. This case, harboring a NOTCH1 mutation, demonstrated the longest durable oncologic response reported in this rare disease. Genomic and molecular testing may play increasingly important roles in the evaluation of these metastases.
Assuntos
Neoplasias Encefálicas/secundário , Carcinoma/secundário , Glândulas Écrinas , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Cranianas/secundário , Neoplasias da Coluna Vertebral/secundário , Neoplasias das Glândulas Sudoríparas/patologia , Parede Abdominal , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/genética , Carcinoma/tratamento farmacológico , Carcinoma/genética , Carcinoma Ductal/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Receptor Notch1/genética , Couro Cabeludo , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagemRESUMO
Recent studies considered surgery as a treatment option for patients with pancreatic ductal adenocarcinoma (PDAC) and synchronous liver metastases. The aim of this study was to evaluate systematically the literature on the role of surgical resection in this setting as an upfront procedure or following primary chemotherapy. A systematic search was performed of PubMed, Embase and the Cochrane Library in accordance with PRISMA guidelines. Only studies that included patients with synchronous liver metastases published in the era of multiagent chemotherapy (after 2011) were considered, excluding those with lung/peritoneal metastases or metachronous liver metastases. Median overall survival (OS) was the primary outcome. Six studies with 204 patients were analyzed. 63% of patients underwent upfront pancreatic and liver resection, 35% had surgery after primary chemotherapy with strict selection criteria and 2% had an inverse approach (liver surgery first). 38 patients (18.5%) did not undergo any liver resection since metastases disappeared after chemotherapy. Postoperative mortality was low (< 2%). Median OS ranged from 7.6 to 14.5 months after upfront pancreatic/liver resection and from 34 to 56 months in those undergoing preoperative treatment. This systematic review suggests that surgical resection of pancreatic cancer with synchronous liver oligometastases is safe, and it can be associated with improved survival, providing a careful selection of patients after primary chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal/secundário , Carcinoma Ductal/cirurgia , Hepatectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Carcinoma Ductal/tratamento farmacológico , Carcinoma Ductal/mortalidade , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/mortalidade , Seleção de Pacientes , Taxa de SobrevidaRESUMO
BACKGROUND: According to the literature and our experience, patients with gastrointestinal metastases are relatively rare. Numerous case reports and literature reviews have been reported. We present one of the larger case series of gastrointestinal metastases. OBJECTIVES: To explore the clinical characteristics and prognosis of patients with gastrointestinal tract metastases, which are rare metastatic sites. METHODS: Patients with gastrointestinal metastases in the setting of stage IV primary carcinomas treated at Beijing Ditan Hospital and Peking University International Hospital from November 1992 to August 2017 were included in this study. The diagnosis of gastrointestinal tract metastases was based on histopathology. RESULTS: 30 patients (median age 56 years, 56.7% female) were included. The most common primary carcinomas associated with gastrointestinal metastases were breast (11 patients, 36.7%), stomach (9 patients, 30.0%), and lung (4 patients, 13.3%) cancer. The major pathological types were adenocarcinoma (16 patients, 53.3%) and ductal carcinoma (9 patients, 30.0%). Ten patients (33.3%) underwent local gastrointestinal treatment, and 20 patients (66.7%) underwent nonlocal treatment (involving chemotherapy alone or best supportive care). For breast cancer patients and gastric cancer patients who underwent local therapy, a significant survival advantage was observed (p = 0.001 and p = 0.012, respectively). The presence of other common metastases was identified as an independent poor prognostic factor through multivariate analysis with a HR (hazard ratio) of survival of 0.182 (95% confidence interval (CI) 0.11-0.523, p = 0.031). CONCLUSION: Gastrointestinal metastases are most frequently from breast invasive ductal carcinoma. The presentation of other common metastases with gastrointestinal metastasis indicates poor prognosis, and selected patients may benefit from surgical intervention.
Assuntos
Adenocarcinoma/secundário , Neoplasias da Mama/patologia , Carcinoma Ductal/secundário , Neoplasias Gastrointestinais/secundário , Neoplasias Pulmonares/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Neoplasias da Mama/mortalidade , Carcinoma Ductal/mortalidade , Carcinoma Ductal/patologia , Feminino , Neoplasias Gastrointestinais/mortalidade , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Gástricas/mortalidadeRESUMO
RATIONALE: Triple-negative breast cancer (TNBC) is associated with unfavorable prognosis due to lack of targeted agents. Bevacizumab, an anti-angiogenic monoclonal antibody against vascular endothelial growth factor A, has shown clinical effects in patients with TNBC. PATIENT CONCERNS: We reported a 49-year-old woman presenting with a giant breast tumor. DIAGNOSES: Stage IV TNBC with chest wall metastasis. INTERVENTIONS: The patient underwent long-term use of bevacizumab combined with chemotherapy. OUTCOMES: The patient was on follow-up for 46 months, a remarkable improvement of the chest wall cutaneous lesion was observed. LESSONS: Bevacizumab may provide benefits for TNBC patients with chest wall metastasis.
Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Carcinoma Ductal/tratamento farmacológico , Carcinoma Ductal/secundário , Neoplasias Torácicas/tratamento farmacológico , Neoplasias Torácicas/secundário , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal/patologia , Cisplatino/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Torácicas/patologia , Parede Torácica/efeitos dos fármacos , Parede Torácica/patologia , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/patologia , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacosAssuntos
Carcinoma Ductal/terapia , Neoplasias da Próstata/terapia , Neoplasias Uretrais/terapia , Retenção Urinária/cirurgia , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Biópsia , Carcinoma Ductal/sangue , Carcinoma Ductal/diagnóstico , Carcinoma Ductal/secundário , Quimioterapia Adjuvante/métodos , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Próstata/patologia , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Radioterapia de Intensidade Modulada , Resultado do Tratamento , Uretra/patologia , Uretra/cirurgia , Neoplasias Uretrais/sangue , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/secundário , Retenção Urinária/etiologiaRESUMO
OBJECTIVE: To describe salivary ductal carcinoma (SDC) presenting as an isolated lesion of the mastoid segment of the facial nerve PATIENTS:: A 70-year-old man presenting with weakness of his right lower lip that progressed to complete facial paralysis over a span of 2 weeks. MAIN OUTCOME MEASURES: Clinical case records, immunohistochemical analyses, and radiological analyses including magnetic resonance imaging and positron emission tomography-computed tomography. RESULTS: Nodular enhancement along the mastoid segment of the facial nerve was identified without any mass within the parotid on magnetic resonance imaging or regional/distant disease on positron emission tomography-computed tomography. Pathologic analysis of tissue obtained from a right parotidectomy, neck dissection, and transmastoid resection of the vertical segment of the facial nerve revealed a benign parotid gland with malignant glands identified intra- and perineurally within the central aspect of the gland. CONCLUSIONS: SDC is one of the most aggressive salivary malignancies and typically presents as a rapidly enlarging mass in the involved gland. Although SDC's clinical course is characterized by early metastasis, isolated neural invasion has not been reported in the absence of an identifiable primary tumor within the gland of origin. The present case illustrates the clinical history and treatment of the first case of a SDC presenting as an isolated facial nerve lesion from perineural spread.
Assuntos
Carcinoma Ductal/secundário , Neoplasias dos Nervos Cranianos/secundário , Doenças do Nervo Facial/patologia , Nervo Facial/patologia , Neoplasias Parotídeas/patologia , Idoso , Carcinoma Ductal/diagnóstico por imagem , Carcinoma Ductal/cirurgia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/cirurgia , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Doenças do Nervo Facial/diagnóstico por imagem , Doenças do Nervo Facial/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Esvaziamento Cervical , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/cirurgia , Resultado do TratamentoRESUMO
We report a case of advanced breast cancer with liver metastasis(T2N1M1, Stage IV )achieving a significant improvement of QOL by multi-disciplinary therapy. The patient was 37-year-old woman who had breast lump and axillary lymph nodes swelling with liver metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, negative for estrogen receptor and progesterone receptor, and positive for HER2/neu protein expression. The Ki-67 positive cell index was 40%. She received 16 courses of DOC plus HER plus PER(docetaxel 75mg/m / 2, trastuzumab 6 mg/kg, pertu- zumab 450mg/body, and received 4 courses of EC(epirubicin 90mg/m / 2, cyclophosphamide 600 mg/m2). The breast lesion and liver metastatic lesion disappeared after chemotherapy. We checked up whole body. There was no metastatic lesion. Therefore, we diagnosed a clinical complete response. We performed muscle preserving mastectomy and axillary lymph nodes dissection. The pathological diagnosis from resected specimens were pathological complete response. The surgical margin was negative. She was started the endocrine therapy by tamoxifen(20mg/day). Three years after surgery, she was well without metastases. Multi-disciplinary therapy can improve patient QOL and the clinical outcomes in Stage IV advanced breast cancer.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Carcinoma Ductal/tratamento farmacológico , Carcinoma Ductal/secundário , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Adulto , Neoplasias da Mama/cirurgia , Carcinoma Ductal/cirurgia , Terapia Combinada , Feminino , Humanos , Estadiamento de Neoplasias , Resultado do TratamentoRESUMO
Objective: to analyze the relation of anatomopathological features and axillary involvement in cases of invasive ductal carcinoma. Methods: this is a cross-sectional study of 220 breast cancer patients submitted to radical mastectomy or quadrantectomy with axilar emptying, from the Mastology Service of the Assis Chateaubriand Maternity School, Ceará, Brazil. We submitted the tumors to histological processing and determined the histological (HG), tubular (TG) and nuclear (NG) grades, and the mitotic index (MI) by the classification of Scarff-Bloom-Richadson, verified the presence of angiolymphatic invasion (AI) and measured the largest tumor diameter (TD). We then correlated these variables with the presence of axillary metastases. Results: the mean patients'age was 56.81 years ± 13.28. Tumor size ranged from 0.13 to 22 cm, with an average of 2.23cm ± 2.79. HG3, TG3 and NG3 prevailed, respectively 107 (48.6%), 160 (72.7%) and 107 (48.6%). Mitotic indexes 1, 2 and 3 presented a homogeneous distribution, respectively 82 (37.2%), 68 (31%) and 70 (31.8%). We observed no relation between the HG, TG and NG with the occurrence of axillary metastases (p=0.07, p=0.22 and p=0.21, respectively). Mitotic indices 2 and 3 were related with the occurrence of axillary metastases (p=0.03). Tumors larger than 2cm and cases that presented angiolymphatic invasion had a higher index of axillary metastases (p=0.0003 and p<0.0001). Conclusion: elevated mitotic indexes, tumors with a diameter greater than 2cm and the presence of angiolymphatic invasion were individuallyassociatedwith the occurrence of axillary metastases.
Objetivo: analisar a relação das características anatomopatológicas com o comprometimento axilar em casos de carcinoma ductal invasor. Métodos: estudo transversal de 220 pacientes com câncer de mama, submetidas à mastectomia radical ou quadrantectomia com esvaziamento axilar, oriundos do Serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil. Os tumores foram submetidos a processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN), índice mitótico (IM) pela classificação de Scarff-Bloom-Richadson, verificada a presença de invasão angiolinfática (IA) e mensurado o maior diâmetro do tumor (DT). Tais variáveis foram correlacionadas com a presença de metástases axilares. Resultados: a média de idade das pacientes foi 56,81 anos ± 13,28. O tamanho do tumor variou de 0,13 a 22 cm, com média de 2,23cm ± 2,79. Os GH3, GT3 e GN3 prevaleceram: n=107 (48,6%), n=160 (72,7%) e n=107 (48,6%), respectivamente. Os índices mitóticos 1, 2 e 3 apresentaram distribuição homogênea: n=82 (37,2%), n=68 (31%) e n=70 (31,8%), respectivamente. Não foi evidenciada relação do GH, GT e GN com a ocorrência de metástases axilares (p=0,07; p=0,22 e p=0,21). Índices mitóticos 2 e 3 apresentaram relação com a o ocorrência de metástases axilares (p=0,03). Tumores maiores do que 2cm e casos com invasão angiolinfática apresentaram maior índice de metástases axilares (p=0,0003 e p<0,0001). Conclusão: índices mitóticos elevados, tumores com diâmetro maior do que 2cm e presença de invasão angiolinfática apresentaram isoladamente relação com a ocorrência de metástases axilares.
Assuntos
Axila , Neoplasias da Mama/patologia , Carcinoma Ductal/patologia , Carcinoma Ductal/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
Despite being discovered almost 50 years ago, little is known regarding the genetic profile of ductal adenocarcinoma of the prostate (DAC). In recent years, progress has been made in the understanding of the genetics of acinar adenocarcinomas, and at least 7 genetically different subtypes have been identified. DAC is known to present at an advanced stage with a high rate of extraprostatic extension and seminal vesicle invasion, and a decreased interval to biochemical recurrence and the development of metastatic disease when compared with acinar adenocarcinoma. Our aim was to investigate the genetic profile of DAC to determine whether there is a genomic rationale for the aggressive behavior associated with this tumor type. Frozen tissue from 11 cases of DAC with paired benign tissue was analyzed. After DNA extraction, copy-number alteration analysis was performed, as well as identification of mutations and indels. We compared the fraction of the DAC genome with copy-number alteration to previous results from 74 primary acinar adenocarcinomas of the prostate. The alteration rate in DAC was comparable to that of acinar adenocarcinoma of high Gleason score. DAC harbored somatic changes seen in advanced and/or metastatic castration-resistant acinar adenocarcinoma, which likely accounts for its aggressive biological behavior.
Assuntos
Biomarcadores Tumorais/genética , Carcinoma Ductal/genética , Perfilação da Expressão Gênica/métodos , Neoplasias de Próstata Resistentes à Castração/genética , Neoplasias da Próstata/genética , Transcriptoma , Idoso , Carcinoma Ductal/secundário , Variações do Número de Cópias de DNA , Análise Mutacional de DNA , Dosagem de Genes , Predisposição Genética para Doença , Humanos , Mutação INDEL , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Fenótipo , Neoplasias da Próstata/patologia , Neoplasias de Próstata Resistentes à Castração/patologia , Carga TumoralRESUMO
ABSTRACT Objective: to analyze the relation of anatomopathological features and axillary involvement in cases of invasive ductal carcinoma. Methods: this is a cross-sectional study of 220 breast cancer patients submitted to radical mastectomy or quadrantectomy with axilar emptying, from the Mastology Service of the Assis Chateaubriand Maternity School, Ceará, Brazil. We submitted the tumors to histological processing and determined the histological (HG), tubular (TG) and nuclear (NG) grades, and the mitotic index (MI) by the classification of Scarff-Bloom-Richadson, verified the presence of angiolymphatic invasion (AI) and measured the largest tumor diameter (TD). We then correlated these variables with the presence of axillary metastases. Results: the mean patients'age was 56.81 years ± 13.28. Tumor size ranged from 0.13 to 22 cm, with an average of 2.23cm ± 2.79. HG3, TG3 and NG3 prevailed, respectively 107 (48.6%), 160 (72.7%) and 107 (48.6%). Mitotic indexes 1, 2 and 3 presented a homogeneous distribution, respectively 82 (37.2%), 68 (31%) and 70 (31.8%). We observed no relation between the HG, TG and NG with the occurrence of axillary metastases (p=0.07, p=0.22 and p=0.21, respectively). Mitotic indices 2 and 3 were related with the occurrence of axillary metastases (p=0.03). Tumors larger than 2cm and cases that presented angiolymphatic invasion had a higher index of axillary metastases (p=0.0003 and p<0.0001). Conclusion: elevated mitotic indexes, tumors with a diameter greater than 2cm and the presence of angiolymphatic invasion were individuallyassociatedwith the occurrence of axillary metastases.
RESUMO Objetivo: analisar a relação das características anatomopatológicas com o comprometimento axilar em casos de carcinoma ductal invasor. Métodos: estudo transversal de 220 pacientes com câncer de mama, submetidas à mastectomia radical ou quadrantectomia com esvaziamento axilar, oriundos do Serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil. Os tumores foram submetidos a processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN), índice mitótico (IM) pela classificação de Scarff-Bloom-Richadson, verificada a presença de invasão angiolinfática (IA) e mensurado o maior diâmetro do tumor (DT). Tais variáveis foram correlacionadas com a presença de metástases axilares. Resultados: a média de idade das pacientes foi 56,81 anos ± 13,28. O tamanho do tumor variou de 0,13 a 22 cm, com média de 2,23cm ± 2,79. Os GH3, GT3 e GN3 prevaleceram: n=107 (48,6%), n=160 (72,7%) e n=107 (48,6%), respectivamente. Os índices mitóticos 1, 2 e 3 apresentaram distribuição homogênea: n=82 (37,2%), n=68 (31%) e n=70 (31,8%), respectivamente. Não foi evidenciada relação do GH, GT e GN com a ocorrência de metástases axilares (p=0,07; p=0,22 e p=0,21). Índices mitóticos 2 e 3 apresentaram relação com a o ocorrência de metástases axilares (p=0,03). Tumores maiores do que 2cm e casos com invasão angiolinfática apresentaram maior índice de metástases axilares (p=0,0003 e p<0,0001). Conclusão: índices mitóticos elevados, tumores com diâmetro maior do que 2cm e presença de invasão angiolinfática apresentaram isoladamente relação com a ocorrência de metástases axilares.
Assuntos
Humanos , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/patologia , Carcinoma Ductal/patologia , Carcinoma Ductal/secundário , Estudos Transversais , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
BACKGROUND: Breast cancer liver metastases (BCLM) are considered the most lethal compared with other sites of metastases in patients with breast cancer. This study aimed to evaluate the outcome after hepatectomy for BCLM within current multidisciplinary treatment and to develop a clinically useful nomogram to predict survival. METHODS: Between January 1985 and December 2012, 139 consecutive female patients underwent liver resection for BCLM at the authors' institution. Clinicopathologic data were collected and analyzed for survival outcome with determination of prognostic factors. A nomogram to predict survival was developed based on a multivariate Cox model. The predictive performance of the model was assessed according to the C-statistic and calibration plots. RESULTS: After a median follow-up period of 55 months, the overall 3- and 5-year survival rates after hepatectomy were respectively 58 and 47 %. The median overall survival period was 56 months, and the median disease-free survival period after surgical resection was 33 months. A single hepatic metastasis, no triple negative tumors, no microscopic vascular invasion, and perioperative hormonal or targeted therapy were related to improved overall survival. The model achieved good discrimination and calibration, with a C-statistic of 0.80. CONCLUSIONS: Liver resection for selected patients with breast cancer metastases can provide significant survival benefit. It should be part of a multidisciplinary treatment program in experienced liver surgery centers. The authors' nomogram facilitates personalized assessment of prognosis for these patients.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal/secundário , Carcinoma Lobular/secundário , Hepatectomia/mortalidade , Neoplasias Hepáticas/secundário , Nomogramas , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Carcinoma Ductal/cirurgia , Carcinoma Lobular/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
A 64-year-old woman visited hospital with a chief complaint of a nodule at the left neck skin. Skin biopsy revealed adenocarcinoma, and the diagnosis was skin metastasis of unknown primary origin. Positron emission tomography and computed tomography showed multiple bone and lymph node metastasis, left breast tumor, bladder tumor, and hydronephrosis. A needle biopsy of breast revealed invasive ductal carcinoma, and transurethral biopsy of bladder revealed adenocarcinoma. The findings were similar to those for the breast and the expression pattern of estrogen-receptor was the same. We diagnosed her with breast cancer and bladder metastasis. We administered systemic chemotherapy, however she died 10 days later. Bladder metastasis of breast cancer is rarely encountered in clinical practice and is often accompanied by life threatening symptoms. Careful histopathological examinations and rapid systemic chemotherapy are significant.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal/secundário , Neoplasias da Bexiga Urinária/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal/tratamento farmacológico , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/tratamento farmacológicoRESUMO
Precision oncology entails making treatment decisions based on a tumor's molecular characteristics. For prostate cancer, identifying clinically relevant molecular subgroups is challenging, as molecular profiling is not routine outside of academic centers. Since histologic variants of other cancers correlates with specific genomic alterations, we sought to determine if ductal adenocarcinoma of the prostate (dPC) - a rare and aggressive histopathologic variant - was associated with any recurrent actionable mutations. Tumors from 10 consecutive patients with known dPC were sequenced on a targeted next-generation DNA sequencing panel. The median age at diagnosis was 59 years (range, 40-73). Four (40%) patients had metastases upon presentation. Archival tissue from formalin-fixed paraffin-embedded prostate tissue samples from nine patients and a biopsy of a metastasis from one patient with castration-resistant prostate cancer were available for analysis. Nine of 10 samples had sufficient material for tumor sequencing. Four (40%) patients' tumors had a mismatch repair (MMR) gene alteration (N = 2, MSH2; N = 1, MSH6; and N = 1, MLH1), of which 3 (75%) had evidence of hypermutation. Sections of the primary carcinomas of three additional patients with known MMR gene alterations/hypermutation were histologically evaluated; two of these tumors had dPC. MMR mutations associated with hypermutation were common in our cohort of dPC patients. Since hypermutation may predict for response to immune checkpoint blockade, the presence of dPC may be a rapid means to enrich populations for further screening. Given our small sample size, these findings require replication.
Assuntos
Biomarcadores Tumorais/genética , Carcinoma Ductal/genética , Reparo de Erro de Pareamento de DNA , Proteínas de Ligação a DNA/genética , Proteína 1 Homóloga a MutL/genética , Proteína 2 Homóloga a MutS/genética , Mutação , Neoplasias da Próstata/genética , Adulto , Idoso , Carcinoma Ductal/mortalidade , Carcinoma Ductal/secundário , Carcinoma Ductal/cirurgia , Análise Mutacional de DNA/métodos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To report a clear cell renal cell carcinoma recipient of a metastasizing ductal carcinoma of the breast: A tumor-to-tumor metastasis. METHODS: A 71 year-old woman with a past history of breast carcinoma, diagnosed 12 years before, underwent a nephrectomy for an incidental kidney mass found in a routine imaging examination. RESULTS: Histological examination revealed foci of ductal carcinoma of the breast in an otherwise typical clear cell renal cell carcinoma of the kidney. Immunohistochemical examination confirmed a metastasis of an infiltrating breast carcinoma to a clear cell renal cell carcinoma (positive to GATA3, hormonal receptors and mamoglobin) in a clear cell renal cell carcinoma (positive to PAX8, CD10 and vimentin). CONCLUSIONS: Awareness of this phenomenon should always be kept in mind by urologist in patients with a known history of a previous malignancy and by pathologists when finding a renal tumor with an unusual or dimorphic morphology. Immunohistochemistry plays an important role to establish the exact diagnosis.