Breast ductal carcinoma and metastatic lymphoma to the contralateral breast in patient with cutaneous non-Hodgkin lymphoma.

Breast lymphoma is a rare condition, both as a primary and a metastatic manifestation. The primary form has an incidence ranging from 0.04% to 0.5% of all breast neoplasms, whereas the metastatic form has an incidence of 0.07%. We hereby report a clinical case of a patient who presented with cutaneous non-Hodgkin lymphoma (NHL) in the left scapulohumeral region treated with surgery followed by radiotherapy (40 Gy total). Three years following radiotherapy, the patient was diagnosed with a left breast infiltrating ductal carcinoma, treated with conservative surgery and adjuvant therapy. The following year, i.e. four years after the initial diagnosis of NHL, two lymphoproliferative relapses occurred: in the left cutaneous scapulohumeral region at the original site of disease, and in the right breast. The aim of this paper is to highlight an uncommon oncologic disorder such as breast lymphoma, highlighting its clinical and radiological manifestations. Some studies reported a possible aetiological role of radiotherapy in the development of breast cancer following treatment of NHL, and in the development of breast cancer following treatment of Hodgkin lymphoma, which could potentially explain our findings.

[Non-palpable lesions of the breast. Preoperative location techniques with vegetable charcoal]. / Lesioni non palpabili della mammella. Tecnica di localizzazione preoperatoria con carbone vegetale.

PURPOSE: Mammography and US increase the rate of early breast cancer diagnoses. The difficult intraoperative location of nonpalpable lesions has led to the development of various techniques suitable to this purpose. We investigated the effectiveness of free-hand vegetable charcoal lesion marking during both mammography and US and compared this technique with other more commonly used methods. MATERIAL AND METHODS: Our series consisted of 485 consecutive charcoal markings of nonpalpable breast lesions submitted to histologic examination. Marking was carried out free-hand under mammographic guidance in 392 cases and under US guidance in 93 cases. The technique, presented in the paper with schematic drawings, was successful because the surgeon correctly identified the charcoal tracing in all 485 cases. There were no complications, neither during charcoal introduction nor during surgery. RESULTS: The comparison with other marking techniques showed the following advantages of our method: 1) it is rapid and easy to perform; 2) patient discomfort is minimal and no local anesthesia is needed; 3) it is accurate and there are no risks of charcoal displacement or spread; 4) the tracing charcoal is easy to find; 5) the most appropriate surgical route can be followed, with consequently better cosmetic results in the patients not undergoing quadrantectomy; 6) surgery can be performed on an outpatient basis under local anesthesia; 7) a minimal amount of glandular tissue is removed; 8) there are absolutely no side-effects; 9) cost is low; 10) surgery can be planned over time; 11) there is no risk of cutting the wire with an electrotome; 12) no particular equipment or instruments are needed; 13) there are no problems in very superficial lesions. CONCLUSIONS: To conclude, on account of our results and of so many advantages, we believe that free-hand vegetable charcoal marking during mammography and US is now the best possible solution to the problem of surgical identification of nonpalpable breast lesions.

[Non-palpable lesions of the breast. Retrospective analysis of mammographic and ultrasonographic indications for surgery]. / Lesioni non palpabili della mammella. Analisi retrospettiva delle indicazioni mammografiche ed ecografiche all'intervento chirurgico.

INTRODUCTION: The differential diagnosis of malignancy in small foci of microcalcifications or in extremely small nodes can be difficult. We carried out a retrospective analysis of integrated mammographic and US results, correlated with histologic data, to assess the limitations of each method and to optimize and benign/malignant ratio. MATERIALS AND METHODS: Our series consisted of 485 nonpalpable breast lesions submitted to histologic examination after vegetable charcoal marking. We gave each lesion an 0-5 score according to the degree of diagnostic doubt/suspicion after mammography and US, which results were correlated with histologic data to assess the carcinoma frequency in the various groups identified. RESULTS: The analysis of mammographic and US images showed that the most frequent mammographic alteration in the lesions submitted to biopsy was an isolated cluster of microcalcifications (40.99%): of these, 36.86% were neoplastic. The nodules submitted to biopsy, which were 29.81% of the total, showed a cancer rate (36.80%) very similar to that of the microcalcifications. The carcinoma rate rose to 37.93% when the microcalcifications were associated with nodes. The highest carcinoma rates, i.e., 52.94% and 66.66%, respectively, were found in parenchymal distortions, either isolated or associated with microcalcifications, which however were only 7.03% and 3.10%, respectively, of the total number of cases. DISCUSSION AND CONCLUSIONS: Our study showed that: 1) a highly suspicious US result must be seriously considered when a negative mammography has poor intrinsic contrast; 2) a highly suspicious US image with a little suspicious good contrast mammography requires further confirmation before surgery is planned; 3) when the mammographic finding is mid-to-highly suspicious, further investigations are needed even if US is negative. To conclude, even though the histologic examination of nonpalpable breast lesions involves performing a biopsy, we believe this is acceptable when performed on an outpatient basis, under local anesthesia and removing a limited amount of tissue only. The benign/malignant ratio ranges 2 to 1.5: if it is further reduced (below 1.5), there will be the risk of missing some early neoplastic lesions.

Breast carcinoma and skeletal formation.

We have studied skeletal structure in 67 women with breast carcinoma and in 59 women without breast carcinoma, looking for differences of development that might be correlated with hormonal, metabolic or genetic abnormalities. We have measured the lengths of the limbs and of their segments (upper arm, forearm, thigh, leg), of the bisacromial and bitrochanteric transverse diameters and total height and height divided into the parts from vertex to pubis and from pubis to the ground. The analysis showed statistically significant coefficients of regression with presence of mammary carcinoma for height (0.0904262, S.D. 0.0461), length of thigh (0.12989, S.D. 0.03981) and length of lower leg (-0.68475, S.D. 0.1390). This skeletal type might be the expression of a genetic condition that is associated with the existence of mechanisms that permit development of mammary cancer.