Breast hematoma with active bleeding due to seat belt injury.

Breast emergencies are not frequent but play an important part in routine breast imaging applications. Diagnosis and identification of seat belt injury in emergency department are essential for patient management and early treatment of advanced cases. Herein we reported imaging findings of a patient who had prominent swollen at her left breast accompanying tissue edema and painful palpable mass formed by active bleeding hematoma as a result of seat belt injury due to a car accident. Radiologic examinations revealed hematoma in the breast accompanying active bleeding.

Machine Learning-Based Ultrasound Texture Analysis in Differentiation of Benign Phyllodes Tumors from Borderline-Malignant Phyllodes Tumors.

PURPOSE: Phyllodes tumors (PTs) are uncommon fibroepithelial breast lesions that are classified as three different forms as benign phyllodes tumor (BPT), borderline phyllodes tumor (BoPT), and malignant phyllodes tumor (MPT). Conventional radiologic methods make only a limited contribution to exact diagnosis, and texture analysis data increase the diagnostic performance. In this study, we aimed to evaluate the contribution of texture analysis of US images (TAUI) of PTs in order to discriminate between BPTs and BoPTs-MPTs. METHODS: The number of patients was 63 (41 BPTs, 12 BoPTs, and 10 MPTs). Patients were divided into two groups (Group 1-BPT, Group 2-BoPT/MPT). TAUI with LIFEx software was performed retrospectively. An independent machine learning approach, MATLAB R2020a (Math- Works, Natick, Massachusetts) was used with the dataset with p < 0.004. Two machine learning approaches were used to build prediction models for differentiating between Group 1 and Group 2. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance of statistically significant texture data between phyllodes subgroups. RESULTS: In TAUI, 10 statistically significant second order texture values were identified as significant factors capable of differentiating among the two groups (p < 0.05). Both of the models of our dataset make a diagnostic contribution to the discrimination between BopTs-MPTs and BPTs. CONCLUSION: In PTs, US is the main diagnostic method. Adding machine learning-based TAUI to conventional US findings can provide optimal diagnosis, thereby helping to choose the correct surgical method. Consequently, decreased local recurrence rates can be achieved.

Predictive Factors for Unnecessary Axillary Dissection According to SLN Metastasis in T1, T2 Stage Breast Cancer.

The axillary nodes' status is essential in determining the treatment algorithm according to complete clinical staging. Unnecessary axillary lymph node dissection (ALND) has been prevented after sentinel lymph node biopsy (SLNB) has occurred in current practice. However, approximately half of patients with positive SLNB do not have axillary metastatic lymph nodes. Our study aims to predict unnecessary ALND in patients with SLN metastases by evaluating the patients' clinicopathological data. In total, 221 patients with macrometastasis in SLNB who underwent completion ALND were evaluated retrospectively. Patients were divided into two groups: patients with metastases only in the sentinel lymph node and additional axillary lymph nodes. Univariate and multivariate logistic regression analyses were used to analyze the correlation between SLN metastasis and axillary lymph node metastasis; clinicopathological characteristics, including patient age, menopause status, tumor size and grade, receptor status proliferative marker status, and molecular subtypes of the tumor. In the evaluation of T1-2, cN0 breast cancer patients with SLNB in the form of macrometastasis, only SLNB metastasis was found in 118 (53.4%) patients. In 103 (46.6%) patients, additional axillary node metastasis was observed. The risk of additional nodal spread correlated with patient age older than fertility age (age of 49) (p = 0.015, OR: 1.96, 95% CI: 1.14-3.39) and the number of increased metastatic sentinel nodes (p < 0.001). In line with the data shown by our study, the rate of axillary metastases increases in patients over the age of fertility and as the number of metastatic SLNs increases.

Applying postoperative radioiodine therapy before 3 months seems to decrease ablation success in patients with differentiated thyroid carcinoma.

OBJECTIVES: Radioiodine can be applied for remnant ablation in low and low to intermediate-risk patients with differentiated thyroid cancer (DTC). A controversy still exists about the application time interval of radioiodine following total thyroidectomy. In this study, we investigated the effect of radioiodine (RAI) therapy timing on the success rates of the ablation. METHODS: We retrospectively reviewed the data of DTC patients who underwent total thyroidectomy and were treated with radioiodine remnant ablation during 2013-2017. Because the objective of this study was to determine the success of ablation according to the postoperative RAI therapy timing, any patients with a pathologic uptake outside the thyroid bed as well as high-risk patients determined before and at RAI therapy were excluded from the study. Finally, 503 patients with low and low to intermediate-risk groups were included in the study. Successful ablation was defined as no visible focal uptake on the neck on I-131 whole body scan with stimulated thyroglobulin (Tg) level of < 1 ng/mL and a normal or undetectable antithyroglobulin antibody (ATG). The time interval from total thyroidectomy to RAI therapy (titRAI) was calculated as months for each patient. RESULTS: A total of 115 (22.9%) patients were in the low to intermediate-risk group whereas most of the patients were at the low-risk group according to the American Thyroid Association (ATA) 2015. Successful ablation was observed in 388 (77.1%) patients. The titRAI was ≤ 3 months in 151 (30.0%) patients and > 3 months in 352 (70.0%) patients. The ratio of successful ablation was statistically higher in patients with a titRAI > 3 months (81.2% of patients) than in patients with ≤ 3 months (67.5% of patients) (χ2 11.247, p 0.001). The rate of successful ablation was 20.3% higher in patients treated after 3 months. There was no statistical difference when titRAI cut off was reduced to 2 months (p > 0.5). CONCLUSION: Investigated the effect of radioiodine therapy initiated before 3 months after total thyroidectomy and it seems to decrease ablation success.

Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery.

BACKGROUND: Surgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE). OBJECTIVE: The aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis. MATERIAL AND METHODS: Data on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study. RESULTS: The concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002). CONCLUSION: IOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.

Management of the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy for breast cancer: A single-center study.

The neoadjuvant chemotherapy (NAC) is the gold standard initial treatment of the locally advanced breast cancer (LABC). However, the reliability of methods that used to assess response the NAC is still controversial. In this study, patients with LABC who underwent NAC were evaluated retrospectively. The assessment of response to NAC and the effect of axillary approach were investigated on LABC course.The study comprised 94 patients who received NAC with an LABC diagnosis between 2008 and 2020. In our center, magnetic resonance imaging, ultrasonography, and F-flouro deoxyglucose positron emission tomography/computed tomography, and, for some patients, fine-needle aspiration biopsy of suspicious axillary lymph nodes have been performed to assess the effects of NAC. Patients with positive hormone receptor status received adjuvant hormonotherapy, and those with human epidermal growth factor receptor 2 gene expression were treated with trastuzumab. Adjuvant radiotherapy was applied to all patients undergoing breast conserving surgery. Radiotherapy was applied to the peripheral lymphatic areas in the clinical N1 to N3 cases regardless of the response to NAC.The clinical response to the NAC was found that partial in 59% and complete in 19% of the patients. However, 21.2% of the patients were unresponsive. The mean of lymph nodes that excised with the procedure of sentinel lymph node biopsy (SLNB) was 2.4 (range 1-7). In 22 of the 56 patients who underwent SLNB, axillary dissection (AD) was added to the procedure upon detection of metastasis in frozen section examinations. There was no difference between the SLNB and AD groups regarding overall survival (OS; P = .472) or disease-free survival (DFS) rates (P = .439). However, there were differences in the OS (P < .05) and DFS (P = .05) rates on the basis of the LABC histopathological subtypes.The study found that a relationship between molecular subtypes and LABC survival. However, the post-NAC axillary approach had no effect on OS or DFS. Therefore, multiple imaging and interventional methods are needed for the evaluation of NAC response. In addition, morbidity can be avoided after AD by the use of SLNB in cN0 patients.

Conventional Imaging and Sonoelastography Findings of Oncocytic Breast Carcinoma in a Man.

Oncocytic breast carcinoma (OBC) is one of the rare types of invasive breast carcinoma in according to the classification of The World Health Organization. Herein we represent imaging findings of a case of 69-year-old male patient with OBC.

Hyperthyroidism with thyroid cancer: more common than expected?

OBJECTIVE: Hyperthyroidism is a group of diseases with many different etiologies and clinical manifestations. The most common causes include toxic multi-nodular goiter, Graves' disease and toxic adenoma. The prevalence of thyroid cancer developing in patients with hyperthyroidism has gradually increased in recent years. The aim of this study is to detect the incidental thyroid cancer rates in patients who have undergone a surgical operation due to hyperthyroidism, and to specify the patient groups in whom surgical treatment should come into the foreground. METHODS: A total of 591 patients, who had surgical excision of the thyroid due to hyperthyroidism between January 2007 and June 2017, were retrospectively analyzed. RESULTS: Of all the patients included in the study, 377 (63.7%) had multi-nodular goiter, 132 (22.3%) had Graves' disease, 55 (9.4%) had nodular Graves' disease, and 27 (4.6%) had toxic adenoma. Thyroid cancer was determined in 131 out of 591 patients (22.6%) who were operated. The most common histologic type was thyroid micropapillary carcinoma (65/131; 49.6%). The accompanying pathologies to thyroid cancer were as follows: Toxic multi-nodular goiter (89/131; 67.9%), nodular Graves' disease (24/131; 18.3%), Graves' disease (13/131; 9.9%) and toxic adenoma (5/131; 2.8%). DISCUSSION: Prevalence of cancer on a background of hyperthyroidism has gradually increased in recent years. It is not realistic to determine thyroid cancer prevalence only based on autopsy examinations. This rate significantly increases in the presence of nodule in clinical studies. Most of the carcinomas are microcarcinomas that do not have lymphovascular invasion and have very low lymph node metastasis. Thus, their treatment is still under debate. KEY WORDS: Hyperthyroidism Micropapillary Cancer, Thyroid cancer.

Comparison of Resection and Liver Transplant in Treatment of Hepatocellular Carcinoma.

OBJECTIVES: Hepatic resection and liver transplant are regarded as 2 potentially curative treatments for hepatocellular carcinoma. Here, we compared both options in patients with hepatocellular carcinoma secondary to cirrhosis seen at a single center over 12 years. MATERIALS AND METHODS: We evaluated early complications and survival of patients with hepatocellular carcinoma treated with liver transplant (57 patients) or hepatic resection (36 patients) at our center between 1998 and 2010. RESULTS: The 34-month mean follow-up period was similar for both treatment groups. The liver transplant group had a longer hospital stay than the hepatic resection group (P ⟨ .001). Patients with Child-Turcotte-Pugh A stage were treated by hepatic resection more than by liver transplant (P ⟨ .001),with Child-Turcotte-Pugh B stage patients treated by liver transplant more than by hepatic resection (P = .03). All patients with Child-Turcotte-Pugh C stage had liver transplant. Both treatment groups had similar postoperative complications and early postoperative mortality rates, but liver transplant resulted in longer overall (P = .001) and higher event-free (P = .001) survival than hepatic resection. Among the liver transplant group, 57.8% of patients met the Milan criteria. Patients who met Milan criteria were treated by liver transplant statistically more than hepatic resection, and these patients had longer overall survival (P = .01) and higher event-free survival (P ⟨ .001) than patients who had hepatic resection. Hepatocellular carcinoma recurrence rates were higher after hepatic resection (P = .232). CONCLUSIONS: In patients with hepatocellular carcinoma, hospital stay was longer after liver transplant, but morbidity and mortality rates for liver transplant versus hepatic resection were similar. However, overall and event-free survival rates were better after liver transplant than after hepatic resection. These results suggest that liver transplant should be considered as the primary treatment option for patients with hepatocellular carcinoma secondary to cirrhosis.

Treatment results in patients with ductal carcinoma in situ treated with adjuvant radiotherapy

Background/aim: The aim of this study was to evaluate the treatment results of patients undergoing adjuvant radiotherapy (ART) after breast surgery with the diagnosis of ductal carcinoma in situ (DCIS). Materials and methods: A total of 61 women who had undergone radiotherapy following extensive surgical excision were enrolled. All patients underwent 50 Gy ART. Survival analysis was performed using Kaplan­Meier analysis and SPSS 20.0. Results: The median age was 52 years (range: 28­86). The median follow-up period after RT was 92 months (range: 23­237). The median overall survival and distant and regional recurrence-free and disease-specific survival was 96 months (range: 26­240), while disease-free and local recurrence-free survival was 96 months (range: 22­240). While the 15-year and 20-year overall survival rates were 87% and 87%, respectively, the recurrence-free survival rates were 98% and 98%, respectively; the rates of disease-specific survival were 100% and 100%, respectively. Conclusion: The results of this study with a long follow-up period have shown that ART in DCIS is an effective treatment method to provide local disease control. However, further large studies are needed to identify the prognostic factors.

Prognostic Importance of Tumor Deposits in the Ipsilateral Axillary Region of Breast Cancer Patients.

Tumor deposits (TD) are irregular discrete tumor masses in adipose tissue, discontinuous from the primary tumor, that are described in various cancers. The incidence and/or prognostic value of TD in breast carcinomas have not been studied so far. We reevaluated 145 breast cancer patients, diagnosed and treated between 2001 and 2006 at our institution for the presence and incidence of TD. Histologic type, grade, size of the primary tumor, estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 status of the tumor, and presence of peritumoral lymphovascular invasion were included in the data. TD were detected in 42 cases (29.0%). The mean age of the patients was 52.2 years (27-82). Most patients (79.3%) had either invasive carcinoma of no special type (NST) or invasive lobular carcinoma, and most tumors (86.9%) were either grade 2 or 3. After excluding TD from the number of metastatic lymph nodes, the pN status of 9 patients changed. Univariate analysis of 110 patients with follow-up information revealed that the new pN status (p = 0.036), presence of local recurrence (p = 0.016) and TD (p = 0.003) were significantly correlated with distant metastases. The median follow-up of the patients was 84 months (5-161), 10-year disease-free survival and overall survival were 67.2% and 73.7%, respectively. In multivariate analysis, presence of TD remained independently associated with distant metastasis (p = 0.002). The probability of distant metastasis was 3.3 times higher in patients with TD. These results emphasize that TD are present in breast cancer patients, and that their presence should warn the clinician in terms of possible distant metastasis. Therefore, presence of TD, the evaluation of which is neither time consuming nor require sophisticated methods, should be included in pathology reports.

Detection of the differences in the apparent diffusion coefficient values in different histopathological types of malignant breast lesions and comparison of cellular region/ stroma ratio and histopathological results

Background/aim: This study aimed to compare the apparent diffusion coefficient (ADC) values of malignant breast lesions with different histopathological types on diffusion-weighted imaging (DWI) and the cellular region/stroma (CR/S) ratio and histopathological results. Materials and methods: Breast diffusion-weighted magnetic resonance findings of 59 patients were retrospectively analyzed for malignant breast lesions. The CR/S ratio was calculated using breast wide-excisional biopsy or mastectomy specimens. Results: Receiver operating characteristic analysis was performed for malignant lesions and subtypes. An ADC threshold of 1.260 × 10 ­3 mm 2 /s was set to detect invasive ductal carcinoma with 80.8% sensitivity and 81.4% specificity. An ADC threshold of 1.391 × 10 ­3 mm 2 /s was set to detect invasive lobular carcinoma lesions with 88.2% sensitivity and 79.5% specificity. The ADC value for lesions with low CR/S ratio (n = 21) was 1.135 ± 0.429 × 10 ­3 mm 2 /s and it was 1.155 ± 0.429 × 10 ­3 mm 2 /s in the high CR/S ratio group (n = 18). Conclusion: ADC value calculation does not seem to be used as an alternative for histopathological detection, which is the gold standard for the differentiation of subtypes of malignant breast cancer. In addition, since there is a positive correlation between CR/S ratio and ADC values, it may be a strong marker to evaluate the stromal component of lesions.

Is the extent of surgical resection important in patient outcome in benign and borderline phyllodes tumors of the breast?

Background/aim: Phyllodes tumors (PTs) of the breast are rare, and their diagnosis and treatment remain controversial. This retrospective study aims to examine the clinical outcome of benign and borderline PTs, according to the surgical margins. Materials and methods: We examined the medical records of 122 patients in our clinic, who had histologically confirmed benign and borderline PTs between 1994 and 2017. Results: The mean age of the patients was 40.6 years (range 18.0-81.0, ±12.1 standard deviation [SD]) and the mean tumor size was 25.8 mm (range 9-65, ±10.3 SD). All patients underwent a breast-conserving procedure and the median follow-up was 51 months. Tumor margins were positive (tumor touching the ink) in 43 patients (35%). Only 16 patients (13%) had margins ≥10 mm. The margins were between 2 and 10 mm in most patients (40%) and ≤1 mm in 12% of the patients. Conclusion: Although no re-excision was performed to obtain grossly clear margins, local recurrence was not observed in any patients. Therefore, revision surgery for close or positive surgical margins for benign and borderline PTs should not be performed as a rule. As most tumors recur within 2 years of diagnosis, we propose a close clinical and imaging follow-up during this period.

Porcine Dermal Collagen Prevents Seroma Formation After Mastectomy and Axillary Dissection in Rats.

OBJECTIVE: Seroma occurs as a result of accumulation lymphovascular liquid in the dead space forming after tissue dissection. It is the most common complication after breast surgery. Collagens are the common component of extracellular matrix and have an important role in wound healing. In this study, we aimed to investigate the efficiency of the Porcine Dermal Collagen in preventing Seroma. MATERIALS AND METHODS: Eighteen young female Wistar rats were used and divided into three groups. Mastectomy and axillary dissection were performed in each group. No other procedures were performed in Group 1 (Control group). Porcine dermal collagen was applied to 50% of the mastectomy field in Group 2 and to 100% of the mastectomy field in Group 3. RESULTS: Seroma volume was significantly decreased in Group 3 in contrast to Groups 1 and 2 (p<0.001) and in Group 2 in contrast to Group 1 (p<0.001). Vascular proliferation, granulation tissue formation and congestion were significantly increased in Group 3 (p<0.05). CONCLUSION: We conclude that the use of Porcine Dermal Collagen reduces the formation of seroma in the model of experimental mastectomy and axillary dissection. As the amount of Porcine Dermal Collagen applied increases the formation of seroma reduces.

Evaluation and comparison of radiologic-pathologic findings in invasive cribriform carcinoma of the breast.

BACKGROUND/AIM: This study aimed to report invasive cribriform carcinoma (ICC) with radiological and histopathologic correlations. MATERIALS AND METHODS: Seventy patients with ICC were classified into two groups; pure ICC patients and patients with >50% cribriform carcinoma component were included in group 1, while patients with <50% cribriform carcinoma component were included in group 2. All patients were reviewed according to American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) lexicon of mammography (MG), ultrasonography (US), and magnetic resonance imaging (MRI). One-way analysis of variance tests and t-tests were used for analysis. P < 0.05 was accepted as statistically significant. RESULTS: Eighteen patients were in group 1 and 52 were in group 2. All patients had MG and US, while 24 patients needed MRI. According to MG ACR BI-RADS lexicon evaluation, irregular shape, spiculated margin and indistinct margin, and high density were statistically significantly higher in group 2 than the other group (respectively P = 0.001, P = 0.001, and P= 0.04). Equal density was statistically significantly higher in group 1 than the other group (P = 0.008). According to US ACR BI-RADS lexicon evaluation, irregular shape, spiculated margins, angular margins, microlobulated margins, and nonparallel orientation were more common US findings in group 2 than the other group (respectively P = 0.001, P = 0.001, P = 0.003, P = 0.04, and P = 0.04). The rate of parallel orientation was higher in group 1 than the other group (P = 0.02). CONCLUSION: Few cases showed benign characteristics and most ICCs appear with typical features of malignancy. Radiologic features of ICC could be better understood and would be helpful for radiologists in diagnosing this rare type of malignancy.

Improvement of colonic healing by preoperative oral partially hydrolyzed guar gum (Benefiber) in rats which underwent preoperative radiotherapy.

BACKGROUND: Neoadjuvant radiotherapy in rectal cancer could interfere with anastomotic healing. We investigated the effects of preoperative oral administration of Benefiber on the healing irradiated colonic anastomosis. METHODS: Forty male Wistar rats were divided into four groups. Group I (control group), Group II (Benefiber® pretreatment group), Group III (preoperative radiotherapy group) and Group IV (preoperative radiotherapy and Benefiber® pretreatment group). All animals underwent 1 cm left colon resection and primary anastomosis. On the 3rd and 7th postoperative days, all the rats were anesthetized to assess the anastomotic healing clinically, mechanically, histologically and biochemically. RESULTS: The mean bursting pressure was significantly lower in-group III and significantly higher in-group II on day 7. The histologic parameters of anastomotic healing, such as epithelial regeneration and formation of granulation tissue, were significantly improved by use of preoperative Benefiber® on day 7. The amount of acid-soluble collagen concentrations significantly increased in-group IV compared to group III on day 3. The amount of salt-soluble collagen concentrations significantly increased in group II compared to group III on day 3. CONCLUSIONS: Colonic anastomotic healing can be adversely affected by preoperative radiotherapy, but orogastric feeding with Benefiber may improve the healing process.

Warthin-like papillary carcinoma of the thyroid: a case series and review of the literature.

Warthin-like tumor of the thyroid is a recently described rare variant of thyroid papillary carcinoma. The distinguishing histological feature of this variant is papillary foldings lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. Its prognosis has been reported to be almost similar to conventional papillary carcinoma. In this case series, we report four cases with Warthin-like papillary carcinoma of the thyroid, diagnosed at Dokuz Eylul University Faculty of Medicine Department of Pathology in 2008 and 2009. Three patients were female. The mean patient age was 39 years (range, 20-56) and the mean tumor size was 1.7 cm (range, 0.9-2.0 cm). All of the cases had lymphocytic thyroiditis in the background. None of the tumors showed lymphovascular invasion. The patients are free of any recurrence and/or distant metastasis with a mean follow-up of 25 months. This rare variant of thyroid papillary carcinoma with distinct histopathological features should be indicated in pathology reports. Further studies and long-term follow-up of patients are needed to highlight the biological behavior of this variant.

Invasive micropapillary carcinoma of the breast: a clinicopathologic study of 103 cases of an unusual and highly aggressive variant of breast carcinoma.

Invasive micropapillary carcinoma (IMPC) of the breast is an uncommon, highly aggressive breast cancer that may occur in pure and mixed forms. Our aim in this study is to investigate the relationship between clinical, histopathologic, and immunohistochemical features of pure and mixed IMPC cases diagnosed and treated at our institution. One hundred and three IMPC cases diagnosed at our institution over a period of 19 years have been selected. Clinical, histopathologic features, as well as hormone status and c-erb-B2 overexpression of tumors were re-evaluated. Mann-Whitney U, chi-squared, Kaplan-Meier, and Fisher's exact tests were used for statistical analyses. Results were considered to be significant at p < 0.05. Twenty cases (19.4%) were pure, and 83 cases (80.6%) were mixed IMPC. The most common nonmicropapillary invasive carcinoma component in mixed cases was invasive ductal carcinoma (IDC; 78.3%). Progesterone receptor was significantly less positive in pure IMPC cases (p = 0.031). There was no statistically significant difference between the two groups, in terms of mean age of the patients (53.0 versus 52.8), mean tumor size (26.6 mm versus 27.7 mm), presence of high-grade tumor (p = 0.631), presence of sentinel lymph node (SN) metastasis (p = 1.000), axillary lymph node metastasis (p = 1.000), lymphatic invasion (p = 1.000) and blood vessel invasion (p = 0.475), c-erbB-2 overexpression of tumor cells (p = 0.616), distant metastasis (p = 0.549), or overall survival (p = 0.759). The local recurrence rate of the two groups was not statistically significant either (16.7% versus 4.3%). However, local recurrence was detected 12% more commonly (p = 0.100), and ~8 months earlier (p = 0.967) in pure IMPC cases, compared to mixed cases. In addition, presence of local recurrence was found to be statistically significantly associated with estrogen receptor (ER) status (p = 0.004), progesterone receptor (PR) status (p = 0.001), and c-erb-B2 overexpression (p = 0.016) in all patients. Overall survival rate was significantly associated with ER staining of the tumor (log-rank = 0.028). Our findings suggest that hormone receptor negativity may explain the more aggressive behavior of pure IMPC compared to mixed cases. Besides, longer survival period of patients with ER positivity, and the relationship of hormone status and c-erb-B2 overexpression and local recurrence further support favorable prognostic value of hormone receptors in invasive breast cancer.