Transformation of a Benign-Appearing Fibroepithelial Lesion to a Giant Malignant Phyllodes Tumor of the Breast.

This is a case of a woman who presented with a left breast mass that was initially diagnosed as fibroadenoma on core biopsy and, after three years without any surgical intervention, was found to be a malignant phyllodes tumor. Initially, a core needle biopsy of the mass showed probable fibroadenoma. Because of the initial benign seeming diagnosis and the need to treat her tongue cancer, the patient did not recognize the need for a recommended surgical consultation and excision. Three years later, she presented after the mass had enlarged to encompass nearly the whole left breast. Core needle biopsy revealed spindle cell proliferation with scattered benign-looking tubules. Due to the large size of the mass, she underwent a total mastectomy, and the final pathology demonstrated a malignant phyllodes tumor. This case demonstrates a case of progression of a benign-appearing fibroepithelial lesion to a malignant phyllodes tumor three years later.

Corrections for mRNA extraction and sample normalization errors find increased mRNA levels may compensate for cancer haplo-insufficiency.

The relative mRNA levels of differentially expressed (DE) and housekeeping (HK) genes of six aneuploid cancer lines with large-scale genomic changes identified by SNP/SKY analysis were compared with similar genes in diploid cells. The aneuploid cancer lines had heterogeneous genomic landscapes with subdiploid, diploid, and supradiploid regions and higher overall gene copy numbers compared with diploid cells. The mRNA levels of the haploid, diploid, and triploid HK genes were found to be higher after correction of easily identifiable mRNA measurement errors. Surprisingly, diploid and aneuploid HK gene mRNA levels were the same by standard expression array analyses, despite the higher copy numbers of the cancer cell HK genes. This paradoxical result proved to be due to inaccurate inputs of true intra-cellular mRNAs for analysis. These errors were corrected by analyzing the expression intensities of DE and HK genes in mRNAs extracted from equal cell numbers (50:50) of intact cancer cell and lymphocyte mixtures. Correction for both mRNA extraction/sample normalization errors and total gene copy numbers found the SUIT-2 and PC-3 cell lines' cancer genes both had ~50% higher mRNA levels per single allele than lymphocyte gene alleles. These increased mRNA levels for single transcribed cancer alleles may restore functional mRNA levels to cancer genes rendered haplo-insufficient by the genetic instability of cancer. © 2013 Wiley Periodicals, Inc.

An update on prognosis in breast cancer patients with extensive axillary disease.

Lymph node (LN) status is the most important factor in predicting survival in breast cancer. Historically, patients with 10 or more positive LN have been thought to have a particularly poor prognosis, which has in the past been used to alter therapeutic recommendations. Studies conducted both prior to and after the use of anthracycline-based chemotherapy demonstrate poor survival. We hypothesized that the current survival rate is considerably higher. All patients with breast cancer treated at our institution between July 1991 and December 2005 with at least 10 positive axillary LN were identified. A multivariate Cox proportional hazards model was performed using age, number of positive nodes, and primary tumor characteristics. Of 55 patients identified, two were excluded for incomplete follow-up information. The median patient age was 53; median follow-up was 5-years. The overall 5-year survival rate was 71.9%. On univariate analysis estrogen receptor (ER) status (p = 0.0001), progesterone receptor status (p = 0.004), use of adjuvant chemotherapy (p = 0.01), T-stage (p = 0.03), and adjuvant hormonal therapy (p = 0.002) were statistically significant for survival. In the multivariate analysis, only ER status and the use of adjuvant chemotherapy remained significant for survival. ER negativity conferred a hazard ratio of 12.6 (95% confidence interval: 3.7-43.2) and the use of adjuvant chemotherapy had a hazard ratio of 0.14 (95% confidence interval: 0.04-0.46). In our study, patients with at least 10 positive axillary LN had a 5-year survival of 71.9% which may be due to the improvements in local and systemic therapy.

Sentinel node mapping for breast cancer: progress to date and prospects for the future.

Sentinel node biopsy (SNB) is indicated for women with small invasive breast cancers and clinically negative nodes. SNB indications are being expanded to larger breast tumors, some cases of ductal carcinoma in situ and selected clinically suspicious nodes. Because SNB has fewer and less severe complications than axillary lymph node dissection, physicians are exploring more ways it can be used to improve breast cancer treatment. The future of SNB includes resolution of the optimal timing of SNB in relation to neoadjuvant chemotherapy and the results of NSABP B-32 and ACOSOG Z10 and Z11. SNB has become the new standard of care for the treatment of early breast cancer.

What is the value of axillary dissection or sentinel node biopsy in patients with ductal carcinoma in situ?

BACKGROUND: Some surgeons have advocated sentinel node biopsy (SNB) for ductal carcinoma in situ (DCIS). The value of the information obtained is not clear. METHODS: From 1972 to 2005, 564 selected patients with pure DCIS had axillary staging with either SNB or axillary lymph node dissection (ALND). Data were collected in a prospective database. RESULTS: Only 2 of 564 patients had positive nodes by hematoxylin and eosin, and they were both in the ALND group. Both patients had mastectomies, were upstaged, received chemotherapy, and survived for more than 10 years without local or distant recurrence. Among 171 patients who had SNB, 10 had isolated tumor cells found by immunohistochemistry. Two patients who underwent SNB had local recurrence, neither developed distant or regional recurrence. Six of 564 patients in the ALND group developed local invasive recurrence and died of metastatic breast cancer, but none of them had positive nodes. CONCLUSIONS: Information from lymph node examination in DCIS patients failed to predict poor outcome. SNB is useful for DCIS in mastectomy, especially with immediate reconstruction. It may be indicated for DCIS at high risk for upgrading to invasive cancer on final excision, but reliable criteria for identifying these tumors are not yet available.

Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins.

BACKGROUND: Margin width has been shown previously to be the most important predictor of local treatment failure after breast conservation for ductal carcinoma in situ (DCIS). METHODS: Five variables thought to be associated with local recurrence were evaluated by univariate and multivariate analysis in 455 nonrandomized patients with DCIS treated with excision alone. RESULTS: Multivariate analysis showed that margin width, age, nuclear grade, and tumor size all were independent predictors of local recurrence, with margin width as the single most important predictor. After adjusting for all other predictors the likelihood of local recurrence for patients with margins less than 10 mm was 5.39 times as much as that for patients with margins of 10 mm or more (95% confidence interval, 2.68-10.64). CONCLUSIONS: Margin width, the distance between DCIS and the closest inked margin, was the single most important predictor of local recurrence. As margin width increases, the risk for local recurrence decreases.