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1.
Medicine (Baltimore) ; 99(31): e21211, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756099

RESUMO

RATIONALE: Within a rapidly expanding therapeutic armamentarium, the combination of everolimus (Eve) plus exemestane (Exe) utility needs to be reinstated in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC). PATIENT CONCERNS: We herein report on a patient affected by HR+ HER2- MBC treated with radical surgery after neoadjuvant chemotherapy, who relapsed early on adjuvant tamoxifen, progressed rapidly on first line anastrozole, and failed treatment with third line capecitabine. DIAGNOSES: Metastatic luminal breast cancer progressed under standard endocrine therapy and chemotherapy. INTERVENTIONS: Third line with Eve plus Exe was given after chemotherapy. OUTCOMES: Patient experienced a 5-year progression free interval. LESSONS: Eve plus Exe remains a valid option in HR+HER2- MBC.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Androstadienos/administração & dosagem , Androstadienos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/mortalidade , Carcinoma Lobular/patologia , Everolimo/administração & dosagem , Everolimo/uso terapêutico , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Pré-Menopausa , Intervalo Livre de Progressão
2.
PLoS One ; 15(7): e0235790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697770

RESUMO

Pleomorphic lobular carcinoma (PLC) is a histological variant of invasive lobular carcinoma (ILC) and is associated with worse prognosis than classical ILC. It exhibits a greater degree of cellular atypia and pleomorphism and is occasionally accompanied with apocrine morphology. We investigated the immunohistochemical characteristics of samples from 31 Japanese patients with PLC to elucidate the clinicopathological characteristics of PLC including androgen receptor (AR) immunoreactivity. The surrogate molecular subtypes were luminal A-like, luminal B-like, luminal B-like/HER2, HER2-type, and triple-negative in 5, 4, 3, 5, and 14 cases, respectively. AR was positive in 92.8% (13/14) of the triple-negative PLC cases and 100% (10/10) of the non-triple-negative PLC cases. Disease-specific survival was worse in patients with histological grade 3 PLCs than in those with histological grade 2 PLCs (p = 0.007). However, there was no significant difference in the progression-free survival between the two groups (p = 0.152). No other clinicopathological characteristics were associated with prognosis. These results reveal that PLC exhibits various surrogate molecular subtypes and that the triple-negative subtype frequently expresses AR. The observed molecular apocrine differentiation implicates that triple-negative PLC can be categorized into the luminal AR subtype. Furthermore, AR-targeted therapy might be useful for patients with triple-negative PLC.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Carcinoma Lobular/patologia , Receptores Androgênicos/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida
3.
Ann R Coll Surg Engl ; 102(6): e118-e121, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32374183

RESUMO

Tumour-to-tumour metastasis is a rare phenomenon. It occurs when a primary tumour is a recipient of a separate tumour within the same individual. We present a case of a 66-year-old woman with known breast cancer who presented with one-sided nasal symptoms. Examination and imaging revealed a unilateral polyp arising from the skull base. She underwent endoscopic polypectomy with the histology demonstrating tumour-to-tumour metastasis from a breast carcinoma to an olfactory neuroblastoma, a rare sinonasal tumour. Clinicians should be cautious of distant metastases in any patient presenting with head and neck symptoms and a known primary tumour. This is the first documented case of this type.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Lobular/secundário , Estesioneuroblastoma Olfatório/diagnóstico , Neoplasias Complexas Mistas/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Neoplasias Nasais/diagnóstico , Idoso , Neoplasias da Mama/terapia , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/cirurgia , Quimioterapia Adjuvante/métodos , Estesioneuroblastoma Olfatório/patologia , Estesioneuroblastoma Olfatório/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Mastectomia , Osso Nasal/diagnóstico por imagem , Osso Nasal/patologia , Osso Nasal/cirurgia , Cavidade Nasal/diagnóstico por imagem , Terapia Neoadjuvante/métodos , Neoplasias Complexas Mistas/patologia , Neoplasias Complexas Mistas/cirurgia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Tomografia Computadorizada por Raios X
4.
Breast Cancer Res Treat ; 181(2): 383-390, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32318957

RESUMO

PURPOSE: Optimizing treatment strategies for patients with inflammatory breast cancer (IBC) relies on accurate initial staging. This study compared contrast-enhanced computed tomography (ce-CT) and FDG-PET/CT for initial staging of IBC to determine the frequency of discordance between the two imaging modalities and potential impact on management. METHODS: 81 patients with IBC underwent FDG-PET/CT and ce-CT prior to starting treatment. FDG-PET/CT and ce-CT scans were independently reviewed for locoregional and distant metastases and findings recorded by anatomic site as negative, equivocal, or positive for breast cancer involvement. Each paired ce-CT and FDG-PET/CT case was classified as concordant or discordant for findings. Discordant findings were subclassified as (a) related to the presence or absence of distant metastases; (b) affecting the locoregional radiation therapy plan; or (c) due to incidental findings not related to IBC. RESULTS: There were 47 discordant findings between ce-CT and FDG-PET/CT in 41 of 81 patients (50.6%). Thirty (63.8%) were related to the presence or absence of distant metastases; most commonly disease detection on FDG-PET/CT but not ce-CT (n = 12). FDG-PET/CT suggested alterations of the locoregional radiation therapy plan designed by CT alone in 15 patients. FDG-PET/CT correctly characterized 5 of 7 findings equivocal for metastatic IBC on ce-CT. CONCLUSIONS: This study demonstrates differences between ce-CT and FDG-PET/CT for initial staging of IBC and how these differences potentially affect patient management. Preliminary data suggest that FDG-PET/CT may be the imaging modality of choice for initial staging of IBC. Prospective trials testing initial staging with FDG-PET/CT versus important clinical end-points in IBC are warranted.


Assuntos
Carcinoma Ductal de Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Fluordesoxiglucose F18/metabolismo , Neoplasias Inflamatórias Mamárias/diagnóstico , Planejamento de Assistência ao Paciente/normas , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/metabolismo , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/metabolismo , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Neoplasias Inflamatórias Mamárias/diagnóstico por imagem , Neoplasias Inflamatórias Mamárias/metabolismo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos/metabolismo , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Estudos Retrospectivos
5.
J Cancer Res Clin Oncol ; 146(6): 1473-1478, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32232656

RESUMO

PURPOSE: Classical type of lobular neoplasia (LN) spans a spectrum of disease, including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), classical lobular neoplasia (LN), and the three-tiered classification of lobular intraepithelial neoplasia (LIN-1, -2, -3). This study addressed inter-observer variability of classical lobular neoplasias (LN) (B3 lesions) in preoperative breast biopsies among breast and gynecopathologists METHODS: A retrospective, observational, cross-sectional study was conducted. 40 preoperative digital images of breast core/vacuum biopsies were analyzed by eight experienced breast- and gynecopathologists. Evaluation criteria were ALH, LCIS, LN classic, LIN-1, LIN-2, LIN-3, focal B3 (one focus), extensive B3 (> one focus). Kappa-index and Chi-square tests were used for statistics. Digital scanned slides were provided to each participant. Agreement between the categories was defined as at least six of eight (cut-off 75%) concordant diagnoses. RESULTS: The highest agreement between eight pathologists was reached using the category lobular neoplasia (LN, classical), 26/40 (65%) cases were diagnosed as such. Agreements in other categories was low or poor: 12/40 (30%) (ALH), 9/40 (22%) (LCIS), 8/40 (20%) (LIN-1), 8/40 (20%) (focal B3), 3/40 (7.5%) (LIN-2), and 2/40 (5%) (extensive B3). Chi-square-test (classical LN versus the other nomenclatures) was significant (p = 0.001137). CONCLUSION: Our data suggest that among Swiss breast pathologists, the most reproducible diagnosis for B3 lobular lesions is the category of classical LN. These data further support lack of consistent data in retrospective studies using different terminologies. Validation of reproducible nomenclature is warranted in further studies. This information is useful especially in view of retro- and prospective data analysis with different diagnostic categories.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Carcinoma Lobular/patologia , Ginecologia , Variações Dependentes do Observador , Patologistas , Biópsia , Neoplasias da Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Estudos Transversais , Feminino , Humanos , Cuidados Pré-Operatórios , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Neurology ; 94(5): e521-e528, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31907288

RESUMO

OBJECTIVE: The primary objective was to determine the sensitivity and specificity of epithelial cell adhesion molecule (EpCAM) immunoflow cytometry circulating tumor cells (CTC) analysis in CSF in patients with suspected leptomeningeal metastases (LM). The secondary objective was to explore the distribution of driver mutations in the primary tumor, plasma, cell free CSF (cfCSF), and isolated CTC from CSF in non-small cell lung cancer (NSCLC). METHODS: We tested the performance of the CTC assay vs CSF cytology in a prospective study in 81 patients with a clinical suspicion of LM but a nonconfirmatory MRI. In an NSCLC subcohort, we analyzed circulating tumor (ct)DNA of the selected driver mutations by digital droplet PCR (ddPCR). RESULTS: The sensitivity of the CTC assay was 94% (95% confidence interval [CI] 80-99) and the specificity was 100% (95% CI 91-100) at the optimal cutoff of 0.9 CTC/mL. The sensitivity of cytology was 76% (95% CI 58-89). Twelve of the 23 patients with NSCLC had mutated epidermal growth factor receptor (EGFR). All 5 tested patients with LM demonstrated the primary EGFR driver mutation in cfCSF. The driver mutation could also be detected in CTC isolated from CSF. CONCLUSION: CTC in CSF are detected with a high sensitivity for the diagnosis of LM. ddPCR can determine EGFR mutations in both cfCSF and isolated CTC from CSF of patients with EGFR-mutated NSCLC and LM. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that EpCAM-based immunoflow cytometry analysis of CSF accurately identifies patients with LM.


Assuntos
Carcinoma/líquido cefalorraquidiano , Carcinomatose Meníngea/líquido cefalorraquidiano , Células Neoplásicas Circulantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma/diagnóstico , Carcinoma/secundário , Carcinoma Ductal de Mama/líquido cefalorraquidiano , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/líquido cefalorraquidiano , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/secundário , Carcinoma Pulmonar de Células não Pequenas/líquido cefalorraquidiano , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma de Células de Transição/líquido cefalorraquidiano , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/secundário , Molécula de Adesão da Célula Epitelial , Receptores ErbB/genética , Feminino , Citometria de Fluxo , Neoplasias Gastrointestinais/patologia , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética , Masculino , Carcinomatose Meníngea/diagnóstico , Carcinomatose Meníngea/genética , Carcinomatose Meníngea/secundário , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Sensibilidade e Especificidade , Carcinoma de Pequenas Células do Pulmão/líquido cefalorraquidiano , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/secundário
7.
J Clin Pathol ; 73(9): 597-601, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31980561

RESUMO

Metaplastic breast carcinoma is a rare subtype of breast cancer. This subtype is mostly found in association with poorly differentiated ductal breast carcinomas and rarely with other breast carcinoma types. We report the case of a 69-year-old woman with an exceptional invasive lobular breast carcinoma associated with metaplastic squamous cell bone metastasis occurring 2 years after the initial breast cancer diagnosis. Whole-exome sequencing and subsequent immunohistochemistry of the lesions were used to link the squamous cell bone metastasis of unknown origin to the primary breast carcinoma initially diagnosed. Searching for primary carcinoma when metastatic lesions of unknown origin occur can be complex. Current molecular biology techniques may help pathologists in associating metastasis with the primary carcinoma by identifying shared specific gene mutations, even when different morphological and immunohistochemical profiles are observed between the tumours.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Sequenciamento Completo do Exoma , Idoso , Neoplasias Ósseas/genética , Neoplasias Ósseas/secundário , Mama/patologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/genética , Carcinoma Lobular/patologia , Exoma/genética , Feminino , Humanos , Imuno-Histoquímica , Metaplasia/patologia , Mutação , Metástase Neoplásica
8.
Am J Case Rep ; 21: e917376, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31927561

RESUMO

BACKGROUND Breast cancer is the most common malignancy in women worldwide. Despite treatment, recurrence and metastasis are common. Lobular breast cancer most commonly metastasizes to the lungs, liver, lymph nodes, and sites in the brain. Metastasis to the gastrointestinal tract is rare, with few cases reported to date. CASE REPORT This report describes a patient with late colon and gastric metastases from lobular breast cancer mimicking primary colon and gastric cancers. CONCLUSIONS Immunohistochemical methods can help differentiate metastatic breast disease to the gastrointestinal tract from primary gastrointestinal malignancy.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Neoplasias do Colo/secundário , Neoplasias Gastrointestinais/secundário , Idoso , Biomarcadores Tumorais , Neoplasias da Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Neoplasias do Colo/diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Feminino , Neoplasias Gastrointestinais/diagnóstico , Humanos , Imuno-Histoquímica
9.
Breast ; 49: 233-241, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31918322

RESUMO

PURPOSE: To investigate the effect of 21-gene recurrence score (RS) on chemotherapy-decision making and prognosis in breast cancer patients aged <40 years. METHODS: Using the Surveillance, Epidemiology, and End Results program, we included patients aged <40 years with tumor size ≤5 cm, node negative, and estrogen receptor-positive breast cancer between 2004 and 2015. Correlations among the 21-gene RS, chemotherapy decision-making and prognosis were analyzed. RESULTS: We included 2721 patients in this study. According to TAILORx cutoffs, 352 (12.9%), 1814 (66.7%), and 555 (20.4%) patients were classified as low-, intermediate-, and high-risk cohorts, respectively. The 21-gene RS categories were associated with the probability of receiving chemotherapy, with 7.1%, 33.4%, and 77.1% of patients in low-, intermediate-, and high-risk cohorts treated with chemotherapy, respectively (P < 0.001). Those in the intermediate-risk cohort were significantly less likely to receive chemotherapy over time (P = 0.008), and the trends of chemotherapy receipt were stable in the low-risk and high-risk cohorts over time. Multivariate analysis showed that the 21-gene RS was an independent prognostic indicator for breast cancer specific survival. In the stratified analysis, the receipt of chemotherapy was associated with better breast cancer specific survival in the high-risk cohort (P = 0.028), but not in the intermediate-risk cohort (P = 0.223). CONCLUSIONS: 21-gene RS has clinical implications for young breast cancer patients with respect to optimizing chemotherapy-decisions. Despite increasing rates of chemotherapy receipt in young patients, more studies are needed to determine the definitive effect of chemotherapy in young patients with three RS categories.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Mama/genética , Regras de Decisão Clínica , Tomada de Decisão Clínica/métodos , Testes Genéticos/métodos , Recidiva Local de Neoplasia/genética , Adulto , Fatores Etários , Biomarcadores Tumorais/genética , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/mortalidade , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/genética , Carcinoma Lobular/mortalidade , Feminino , Seguimentos , Perfilação da Expressão Gênica , Humanos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/prevenção & controle , Prognóstico , Estudos Retrospectivos , Medição de Risco , Programa de SEER , Análise de Sobrevida
10.
Asian Pac J Cancer Prev ; 21(1): 133-137, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31983175

RESUMO

INTRODUCTION: Breast cancer (BC) is the most common malignancy affecting females worldwide. Various risk factors play a role in the developing of BC. Infectious agents like viruses have been proposed for this cancer and Epstein-Barr virus (EBV) is a widely researched candidate virus. This study detects the presence of EBV-DNA in breast cancer patients. METHODS: The study was conducted on 59 formalin-fixed paraffin-embedded (FFPE) tissue blocks samples of women with breast carcinoma and 11 non-neoplastic breast controls. The DNA was extracted for all the samples. Then detection of EBNA1 EBV was done by polymerase chain reaction (PCR). RESULTS: EBV was detected in 6.7% (4/59) of patients while all breast control samples were negative. All patients with positive EBV-DNA were high tumor grades (II, and III). Also, they had a low level of educations. CONCLUSIONS: According to our findings, it can be suggested that EBV may have a potential role in breast cancer development. However, this study provides substantial but not conclusive evidence for the involvement of viruses in BC disease development. Therefore, future investigations are needed to elucidate the exact role of EBV in breast cancer.
.


Assuntos
Neoplasias da Mama/epidemiologia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Lobular/epidemiologia , Infecções por Vírus Epstein-Barr/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/virologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/virologia , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/virologia , DNA Viral/análise , DNA Viral/genética , Infecções por Vírus Epstein-Barr/virologia , Feminino , Seguimentos , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/isolamento & purificação , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Prevalência , Prognóstico
11.
Breast ; 49: 93-100, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31783315

RESUMO

BACKGROUND: Metastatic regional lymph nodes (LN) is a strong predictor of worse long-term outcome. Therefore, different LN staging systems have been proposed in recent years. In this study, we proposed a modified lymph node ratio (mLNR) as a new lymph node staging system and then compared the prognostic performance of mLNR with American Joint Committee on Cancer N stage, lymph node ratio (LNR) and log odds of metastatic lymph nodes in breast cancer patients. METHODS: Breast cancer patients who underwent surgery between 2004 and 2012 were identified from the Surveillance, Epidemiology, and End Results database. Restricted cubic spline functions were calculated to characterize the association between variables and the risk of death. The Cox proportional hazards models were constructed to assess the predictive ability of different lymph node staging systems using the Akaike's Information Criterion (AIC) and Harrell's concordance index (C-index). RESULTS: A total of 264,096 breast cancer patients were enrolled and 187,785 (71.1%) patients had a limited number of LNs harvested. In the limited LN harvest cohort, the prognostic performance of LNR decreased and mLNR could greatly solve this problem. In addition, among the entire cohort, mLNR modeled as a continuous value had the best predictive ability (AIC: 922021.9 and C-index: 0.727) than other lymph node staging systems. CONCLUSIONS: The predictive ability of LNR is restricted by a limited LN harvest. However, mLNR shows superiority to LNR and other lymph node staging systems especially in a limited LN harvest cohort, making mLNR the most powerful lymph node staging systems.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/patologia , Razão entre Linfonodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/terapia , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/mortalidade , Carcinoma Lobular/terapia , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Programa de SEER , Análise de Sobrevida , Adulto Jovem
12.
Virchows Arch ; 476(2): 209-217, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31776645

RESUMO

Management of classic lobular neoplasia (cLN) diagnosed on core needle biopsy (CNB) is controversial. Our aim in this study was to review cases of cLN diagnosed on CNB to determine the rate and risk factors of an upgrade to ductal carcinoma in situ (DCIS) or invasive carcinoma on excision. All breast CNBs with a diagnosis of atypical lobular hyperplasia (ALH) or classic lobular carcinoma in situ (cLCIS) from three different institutions within a single health care system between 2013 and 2018 were retrieved. Cases with any additional high-risk lesions in the same CNB or discordant radiological-pathological correlation were excluded. Information about age, personal history of prior or concurrent breast cancer (P/CBC), and radiological and histological findings were recorded. A total of 287 cLN cases underwent surgical excision. Analysis of these 287 cLN cases showed 11 (3.8%) upgrade lesions on excision. Among the 172 ALH cases, there were 3 (1.7%) upgrades, which were all invasive lobular carcinomas (ILCs). On the other hand, 8 of 115 (7%) cLCIS cases revealed upgrade on excision (2 ILC, 5 DCIS. and 1 ILC + DCIS). Statistical analysis revealed that cLN cases with P/CBC, radiological asymmetry, or architectural distortion had a statistically significant higher upgrade rate on excision. Our findings revealed a low upgrade rate (3.8%) on the excision of classic lobular neoplasia diagnosed on breast core needle biopsy. Clinicoradiological surveillance can be appropriate when lobular neoplasia is identified on core biopsy with pathological radiological concordance in patients without a history of breast cancer, with the caveat that radiological asymmetry and architectural distortion are associated with a significant increase in an upgrade on excision.


Assuntos
Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/métodos , Mama/patologia , Carcinoma de Mama in situ/patologia , Carcinoma in Situ/patologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Lobular/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Estudos Retrospectivos
13.
In Vivo ; 34(1): 355-359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882499

RESUMO

BACKGROUND/AIM: The histopathological assessment of the B5c category may sometimes be hampered by simple artifacts that may lead to over- or underestimation of that particular breast cancer so that its management is still controversial, especially with regard to the decision to proceed immediately to sentinel lymph node (SLN) biopsy. Hence, a retrospective study was performed in 174 patients undergoing breast-conserving surgery with a preoperative diagnosis of B5c in order to assess the usefulness of axillary node staging by means of SLN biopsy. PATIENTS AND METHODS: Pre- and post-operative parameters including imaging data, histology of the primary tumor and SLN biopsy, biological prognostic factors, type of operation, and adjuvant regimens were computed. RESULTS: Invasive carcinoma and carcinoma in situ were diagnosed in 46 (26.5%) and 128 patients (73.5%), respectively. Preoperative tumor size was significantly related to post-operative diagnosis of invasive carcinoma (p=0.020), retaining its predictive value at logistic regression analysis (p=0.046). Post-operative predictive factors of invasion were represented by tumor stage (p=0.008) and grading (p=0.008). CONCLUSION: B5c preoperative diagnosis in patients undergoing breast conservative surgery would suggest an immediate wide local excision avoiding any further preoperative histologic assessment. Conversely, one-stage SLN biopsy might be suggested for patients eligible to mastectomy, similar to patients with carcinoma in situ, although its impact on the therapeutic and prognostic assessment seems negligible.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Lobular/diagnóstico , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/cirurgia , Feminino , Seguimentos , Humanos , Linfonodos/cirurgia , Mastectomia , Invasividade Neoplásica , Prognóstico , Estudos Retrospectivos
15.
Int J Surg Pathol ; 28(2): 169-172, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31619100

RESUMO

Carcinomas in the breast with a predominantly clear cytoplasm are rare. In this article, we review the differential diagnosis of clear cell breast neoplasms and report a case of invasive lobular carcinoma with extensive clear cell morphology that was diagnosed as invasive ductal carcinoma, not otherwise specified, on ultrasound-guided biopsy. Lobular carcinomas with extensive clear cell change are unusual, but must be considered when evaluating a clear cell neoplasm in the breast.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/patologia , Idoso , Biópsia , Carcinoma Ductal de Mama/patologia , Erros de Diagnóstico , Feminino , Humanos , Ultrassonografia de Intervenção
16.
Ann Surg Oncol ; 27(3): 736-740, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31559544

RESUMO

BACKGROUND: The Tyrer-Cuzick model has been shown to overestimate risk in women with atypical hyperplasia, although its accuracy among women with lobular carcinoma in situ (LCIS) is unknown. We evaluated the accuracy of the Tyrer-Cuzick model for predicting invasive breast cancer (IBC) development among women with LCIS. METHODS: Women with LCIS participating in surveillance from 1987 to 2017 were identified from a prospectively maintained database. Tyrer-Cuzick score (version 7) was calculated near the time of LCIS diagnosis. Patients with prior or concurrent breast cancer, a BRCA mutation, receiving chemoprevention, or with pleomorphic LCIS were excluded. Invasive cancer-free probability was estimated using the Kaplan-Meier method. RESULTS: A total of 1192 women with a median follow-up of 6 years (interquartile range [IQR] 2.5-9.9) were included. Median age at LCIS diagnosis was 49 years (IQR 45-55), 88% were white; 37% were postmenopausal, 28% had ≥ 1 first-degree family member with breast cancer, and 13% had ≥ 2 second-degree family members with breast cancer. In total, 128 patients developed an IBC; median age at diagnosis was 54 years (IQR 49-61). Five- and 10-year cumulative incidences of invasive cancer were 8% (95% confidence interval [CI] 6-9%) and 14% (95% CI 12-17%), respectively. The median Tyrer-Cuzick 10-year risk score was 20.1 (IQR 17.4-24.3). Discrimination measured by the C-index was 0.493, confirming that the Tyrer-Cuzick model is not well calibrated in this patient population. CONCLUSIONS: The Tyrer-Cuzick model is not accurate and may overpredict IBC risk for women with LCIS, and therefore should not be used for breast cancer risk assessment in this high-risk population.


Assuntos
Carcinoma de Mama in situ/diagnóstico , Neoplasias da Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Modelos Estatísticos , Medição de Risco/normas , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Ann Surg Oncol ; 27(2): 375-383, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31407178

RESUMO

BACKGROUND: Routine performance of internal mammary sentinel lymph node biopsy (IM-SLNB) remains a subject of debate due to no clinical relevance in breast cancer, because it was performed only in clinically axillary lymph node (ALN)-negative patients. In this study, IM-SLNB was performed in clinically ALN-positive patients, and its impact on nodal staging and therapeutic strategy were subsequently analyzed. METHODS: Clinically ALN-positive patients who underwent IM-SLNB were enrolled in this prospective study. Statistical analysis was performed using Chi square test, Mann-Whitney U and logistic regression models with a significance level of 0.05. RESULTS: Among the 352 recruited patients, the internal mammary sentinel lymph node (IMSLN) visualization rate of patients who received initial surgery and neoadjuvant systemic therapy (NST) was 71.9% (123/171) and 33.1% (60/181), respectively. The 183 patients who underwent IM-SLNB successfully had the average time duration of 7 min and the median IMSLN number of 2. There were 87 positive IMSLNs in all the 347 removed IMSLNs, which were mainly concentrated in the second (50.6%) and third (34.5%) intercostal space. The IMSLN metastasis rate was 39.8% (initial surgery) and 13.3% (NST), respectively. All of the 183 IM-SLNB patients received more accurate nodal staging, 57 of whom had stage elevated, which might have prompted modifications to the therapeutic strategy. CONCLUSIONS: IM-SLNB should be routinely performed in clinically ALN-positive patients, and thus more accurate nodal staging and perfect pathologic complete response definition could be put forward. The identification of IMLN metastases by IM-SLNB might potentially influence therapeutic strategies.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Linfonodos/patologia , Adulto , Idoso , Axila , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/cirurgia , Estudos de Casos e Controles , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Linfonodos/cirurgia , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Estudos Prospectivos , Biópsia de Linfonodo Sentinela
19.
Pan Afr Med J ; 37: 343, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33738031

RESUMO

Male breast cancer is a rare disease accounting for less than 1% of all breast cancer diagnoses worldwide to our knowledge. The aim of this retrospective study is to analyse the epidemiologic, clinical, therapeutic and evolutive profiles of this disease and to compare some cancer aspects between male and female in 25 cases collected at Mohamed VI Oncology Center at the University Hospital of Casablanca between 2012 and 2018. Of all breast cancers, men with breast cancer make up a minority. Male compared to female breast cancers occurred later in life with higher stage and more estrogen receptor-positive tumors. The median age was 67.7 years. The average diagnosis delay was 15.7 month. Cancer was discovered through self examination in 76.1% of cases. The mean diameter was 3.5 cm and range from 1-6 cm. According to the tumor-node-metastasis (TNM) classification, tumors were classified as T1-T2 (40%) and T3-T4 (60%). Infiltrating ductal carcinoma was the most frequent (92%) and 1 case of lobular carcinoma. Axillary nodal involvement was present in 82.4% of cases. Hormonal receptors were positive in 83% of cases. 86.6% of our cases present metastasis. Bone was the most representative site. Surgery was usually mastectomy with axillary clearance. It was possible to follow 21 of the patients. The median of follow-up was 12 months. The evolution has been characterized by local recurrence in 6 cases. There was 9 cases of death. Death was usually due to comorbid disease and to the advanced age. The 5 years overall survival rates were 57%.


Assuntos
Neoplasias da Mama Masculina/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Lobular/diagnóstico , Mastectomia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/patologia , Carcinoma Lobular/cirurgia , Diagnóstico Tardio , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida
20.
Pan Afr Med J ; 34: 70, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31819786

RESUMO

Invasive lobular carcinoma (ILC) of the breast accounts for 5-15% of breast cancers. It is classified as the second most frequent histological type after non-specific invasive cancer (NSIC) and its prevalence has seen a marked increase. Clinical and radiological diagnosis is difficult. Usually, this cancer develops bilaterally and more slowly than non-specific invasive cancer, with best prognostic factors. The purpose of our study was to describe in detail the clinical, radiological, therapeutic and prognostic features of invasive lobular carcinoma. We conducted a retrospective descriptive study of 30 cases with ILC of the breast whose data were collected at the Center of Maternity and Neonatology, Monastir over a period of 10 years. The prevalence of ILC was 5.2%. The average age of patients was 53.43 years. Ten percent of patients had a personal history of benign mastopathies, 6.66% had a personal history of breast cancer and 3.33% had a family history of breast cancer. Late-stage diagnosis was made in 18 cases. Bifocal mass was found in 5 patients, multifocal mass in 4 patients and bilateral mass in 3 patients. Only one patient had liver metastasis at the time of diagnosis. Radical mastectomy (Patey) was immediately performed in 63.33% of patients. Anatomo-pathological examination showed multifocal lesions in 44.80% of cases. Lymph node dissection was satisfactory in 21 patients; 28 patients (93.33%) underwent radiotherapy and adjuvant hormonal therapy. Five-year overall survival was 77.3%.


Assuntos
Neoplasias da Mama/terapia , Carcinoma Lobular/terapia , Mastectomia/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/patologia , Feminino , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Prevalência , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
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