OBJECTIVETo assess the diagnostic value of core needle biopsy (CNB) before neoadjuvant chemotherapy for breast cancer.

METHODSOne hundred and nineteen breast cancer cases underwent neoadjuvant chemotherapy in our hospital during the period from June, 2005 to January, 2007 were analyzed. CNB was carried out before starting chemotherapy. The hematoxylin and eosin-stained slides of CNB taken before and after neoadjuvant chemotherapy were reviewed independently by two pathologists, and the rate of consistency was verified.

RESULTSAmongst the 119 cases studied, 110 cases were confirmed to be carcinoma, including 105 cases of invasive carcinoma and 5 cases of ductal carcinoma-in-situ. The rate of consistency was 97.22% (105/108).

CONCLUSIONCNB has important value in distinguishing benign from malignant lesions, as well as in confirming the diagnosis of invasive carcinoma before starting neoadjuvant chemotherapy.

Biopsy, Needle ; methods ; utilization ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; drug therapy ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Female ; Humans ; Neoadjuvant Therapy ; methods

OBJECTIVETo investigate the clinical value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing pathologic responses in breast cancer treated with neoadjuvant chemotherapy.

METHODSForty-five patients with pathologically confirmed breast carcinoma who finished last course of neoadjuvant chemotherapy underwent preoperative breast MRI. All the specimen slices were blindly reviewed by one pathologist. Pathologic response was assessed according Miller & Payne five-point classification, of which grade 5 defined as pathological complete response (pCR) , and grade 5 or 4 defined as major histological response (MHR). DCE-MRI images were blindly reviewed by two radiologists retrospectively on workstation with Functool software. Any non-vessel enhancement in previous tumor bed in any phase of postcontrast acquisition was defined as residual disease. The diagnostic results of two radiologists were correlated to pathological gold standard. Inter-observer consistency was analyzed by Kappa statistics.

RESULTSDCE-MRI for pathological invasive (pINV) residual disease detection in two radiologists had sensitivities of 94.7% and 97.4%, specificities of 42.8% and 57.1%, and accuracy of 86.6% and 91.1%, respectively, while MHR evaluation had sensitivities of 95.5% and 81.8%, specificities of 73.9% and 82.6%, and accuracies of 84.4% and 82.2%, respectively. K values in determine pINV and MHR were 0.728 and 0.778, respectively, showing good inter-observer consistency.

CONCLUSIONDCE-MRI is sensitive in detecting residual breast cancer after neoadjuvant chemotherapy, and can be used to predict the postoperative pathologic response.

Breast Neoplasms ; diagnosis ; drug therapy ; pathology ; Contrast Media ; Female ; Humans ; Magnetic Resonance Imaging ; Neoadjuvant Therapy ; Neoplasm, Residual ; Sensitivity and Specificity

OBJECTIVETo investigate general and clinicopathological characteristics of male breast cancer and analyzed the factors affecting the outcomes of the patients based on the data from a single institution.

METHODSTwenty-five male breast cancer patients treated at Sun Yet-sen University Cancer Center between January 1, 2000 and April 30, 2011 were included into the study. The patients were followed up for 1 to 90 months with a median follow-up of 51 months. The general and clinicopathological characteristics including family history, age, smoking, alcohol drinking, site of tumor, location of tumor, histological type, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67, vascular endothelial growth factor (VEGF), P53 expression, neoadjuvant chemotherapy, surgery, adjuvant chemotherapy, adjuvant radiotherapy, adjuvant endocrine therapy, tumor size, lymph node status, distant metastasis and TNM stage were investigated by univariate analysis to evaluate the impact of these factors on patient survival.

RESULTSThe 5-year survival rate was 66.5% in these patients. Neoadjuvant chemotherapy, tumor size, lymph node status, distant metastasis and TNM stage were significant predictors for the overall survival. Patients receiving adjuvant endocrine therapy tended to have a better overall survival, though this was not supported statistically (P=0.086). However, patients with neoadjuvant chemotherapy had a poorer overall survival than those without it (P=0.000). Patients in stages I and II had better overall survival than those in stages III and IV (P=0.000).

CONCLUSIONThe 5-year survival rate was 66.5% in these male breast cancer patients. Neoadjuvant chemotherapy, tumor size, lymph node status, distant metastasis and TNM stage are significant predictors of the overall patient survival.

Breast Neoplasms, Male ; diagnosis ; drug therapy ; pathology ; Follow-Up Studies ; Humans ; Male ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Survival Rate

Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding.
Abdomen/diagnostic imaging ; Aged ; Antimetabolites, Antineoplastic/therapeutic use ; Ascites ; Breast Neoplasms/pathology ; Colonoscopy ; Female ; Fluorouracil/therapeutic use ; Humans ; Laparoscopy ; Peritoneal Neoplasms/*diagnosis/drug therapy/pathology ; Peritoneum/pathology ; Pseudomyxoma Peritonei/*diagnosis/drug therapy/pathology ; Tomography, X-Ray Computed

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast ; pathology ; Breast Neoplasms ; drug therapy ; pathology ; Cyclophosphamide ; therapeutic use ; Diagnosis, Differential ; Doxorubicin ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Lymphoma, B-Cell ; drug therapy ; pathology ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; pathology ; Male ; Middle Aged ; Prednisone ; therapeutic use ; Sarcoma ; pathology ; Spleen ; pathology ; Splenic Neoplasms ; drug therapy ; pathology ; Vincristine ; therapeutic use

Azathioprine (AZA) treatment in transplant or autoimmune patients and subsequent appearance squamous cell carcinomas at various sites, particularly skin and cervix, has shown a close relationship. However, it remains uncertain whether this is true for the patients with Crohn's disease. We report a case of squamous cell carcinoma of the breast occurred in a 35-year-old female with Crohn's disease taking AZA. She was first diagnosed with Crohn's disease 10 years ago and has taken AZA with 5-aminosalicylic acid (5-ASA) on regular follow up in gastrointestinal department for 9 years. She had no family history of breast cancer. She visited breast cancer clinic due to incidentally found right breast mass. A mastectomy on the right breast was performed and 6.3x5.5 cm mass was removed. The mass was microscopically proven to be poorly differentiated squamous cell carcinoma with focal keratin pearl formation. At age of 25, she was first diagnosed with active Crohn's disease. 5-ASA and corticosteroid induced remission. Then, steroid was tapered off and AZA was maintained at 1 mg/kg due to leukopenia at higher dose. She stopped taking AZA at her discretion during her two pregnancies and reported total of 67 months of AZA medication on her breast cancer diagnosis.
Adult ; Azathioprine/*therapeutic use ; Breast Neoplasms/*diagnosis/pathology/therapy ; Carcinoma, Squamous Cell/*diagnosis/pathology/therapy ; Colonoscopy ; Combined Modality Therapy ; Crohn Disease/*drug therapy ; Female ; Humans ; Immunosuppressive Agents/*therapeutic use ; Mesalamine/therapeutic use ; Positron-Emission Tomography

OBJECTIVETo evaluateclinical features, treatment and outcomes of patients diagnosed with primary breast diffuse large B-cell lymphoma（DLBCL）.

METHODSClinical data were analyzed for all patients diagnosed with primary breast DLBCL（n=21）. Kaplan-Meier method was used to estimate 5- year overall survival（OS）rate, and the difference was compared by Log- rank test.

RESULTSThe 21 cases of patients with primary breast DLBCL were all female with median age at diagnosis as 48 years （range 21-64 years）. 13 patients had International Prognostic Index（IPI）of 0, 6 IPI 1, and 2 IPI 2. The 5- year OS rates of CHOP/R- CHOP and R±DICE after R±EPOCH groups were 40.0% and 72.2% , respectively（P=0.035）. The central nervous system relapse rate of CHOP/R-CHOP and R±DICE after R± EPOCH groups were 16.7% and 6.7%（P=0.500）, respectively. The 5- year OS rates of patients with primary breast DLBCL staging Ⅱ E-Ⅲ E and Ⅰ E were 21.4% and 83.3% , respectively（P=0.025）.

CONCLUSIONPrimary breast DLBCL was rare. The patients of primary breast DLBCL with chemotherapy regimen of R±DICE after R±EPOCH might have a better prognosis and lower relapse rate of central nervous system; the primary breast DLBCL patients staging ⅡE-ⅢE might have a poor prognosis.

Antibodies, Monoclonal, Murine-Derived ; Antineoplastic Combined Chemotherapy Protocols ; Breast Neoplasms ; diagnosis ; drug therapy ; pathology ; China ; Cisplatin ; Cyclophosphamide ; Dexamethasone ; Doxorubicin ; Etoposide ; Female ; Humans ; Ifosfamide ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; drug therapy ; pathology ; Neoplasm Recurrence, Local ; Prednisone ; Prognosis ; Retrospective Studies ; Vincristine

Antineoplastic Agents, Hormonal ; therapeutic use ; Breast Neoplasms ; classification ; drug therapy ; pathology ; surgery ; Carcinoma in Situ ; drug therapy ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; drug therapy ; pathology ; surgery ; Carcinoma, Lobular ; drug therapy ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Mastectomy ; Precancerous Conditions ; drug therapy ; pathology ; surgery ; Tamoxifen ; therapeutic use

OBJECTIVETo study the clinicopathologic features, immunophenotypes and differential diagnoses of invasive carcinoma arising in breast microglandular adenosis (MGACA).

METHODSClinical and pathologic findings of 3 cases of MGACA were analyzed by histomorphology and immunohistochemical staining of CK7, S-100 protein, ER, PR, HER2, SMA, MSA, p63 and PAS. Literatures were reviewed.

RESULTS(1) Histologically, 3 tumors all showed a spectrum of glandular proliferations ranging from microglandular adenosis (MGA) to atypical microglandular adenosis (AMGA) to in situ carcinoma (DCIS) to invasive carcinoma. The invasive carcinoma component was ductal in case 1, and matrix-producing in case 2 and case 3. (2) All epithelial cells in MGA, AMGA, DCIS and MGACA were positive for CK7 and S-100 protein, but were negative for ER and HER2. PR was negative in case 1 and case 2 but was low positive in case 3. Myoepithelial cell differentiation was not demonstrated in MGA, AMGA, DCIS and MGACA by immunohistochemical staining for SMA, MSA or p63. PAS staining showed the presence of basement membrane in MGA, AMGA and DCIS, except MGACA.

CONCLUSIONSMGACA is an extremely rare tumor of the breast and has distinct morphological and immunohistochemical features. Further studies are needed to evaluate the clinical behavior of this rare neoplasm.

Adult ; Breast Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; Carcinoma, Ductal, Breast ; drug therapy ; metabolism ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; drug therapy ; metabolism ; pathology ; surgery ; Cell Transformation, Neoplastic ; Diagnosis, Differential ; Disease Progression ; Female ; Fibrocystic Breast Disease ; drug therapy ; metabolism ; pathology ; surgery ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratin-7 ; metabolism ; Mastectomy, Modified Radical ; Middle Aged ; Precancerous Conditions ; drug therapy ; metabolism ; pathology ; surgery ; Receptors, Progesterone ; metabolism ; S100 Proteins ; metabolism

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.
Adenocarcinoma/drug therapy/*secondary ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biopsy, Needle ; Bone Neoplasms/secondary ; Breast Neoplasms/drug therapy/*secondary ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoplasm Staging ; Tomography, X-Ray Computed ; Ultrasonography, Mammary