OBJECTIVE: The aim of this study is to investigate the effect of tamoxifen on endometrial thickness in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer after chemotherapy. METHODS: Fifty-eight tamoxifen-treated postmenopausal breast cancer patients underwent periodically transvaginal ultrasonography twice a year for 2 years and then once a year. We analyzed the correlation between the sonographic endometrial thickness and the duration of tamoxifen therapy. RESULTS: The mean endometrial thickness of breast cancer patients before tamoxifen therapy was 4.68 mm. But the mean endometrial thickness increased to 5.03 mm at 6 months, 5.21 mm at 12 months, after which it slightly declined to 5.13 mm at 18 months. And then it increased to 5.15 mm at 24 months, and 5.24 mm at 36 months. There was a significant increase in endometrial thickness after tamoxifen therapy compared with before tamoxifen therapy (p<0.05). Overall, proliferative endometrium was the most common histopathologic finding (5/14) in tamoxifen-treated postmenopausal women who had endometrial thickness >or=5 mm. No cases of endometrial cancer were detected. CONCLUSION: Significant increase in endometrial thickness with the duration of tamoxifen therapy in postmenopausal tamoxifen-treated patients may be associated with a high risk of endometrial pathologies in these patients.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Pathology ; Tamoxifen ; Ultrasonography

We report the case of a 20-year-old female with lymphoma of the breast. Mammography showed an asymmetric pattern of confluent densities without any discrete mass. Sonography revealed diffuse heterogenous echoic mass intermingled with low-and medium level echoes. We present the clinical, radiographic and histologic features of primary breast lymphoma with a brief review of the literatures.
Adult ; Breast Neoplasms/*pathology/therapy/ultrasonography ; Female ; Humans ; Lymphoma/*pathology/therapy/ultrasonography ; Mammography ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology/therapy/ultrasonography

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.
Adult ; Breast Neoplasms/drug therapy/radiography/*secondary/ultrasonography ; Diagnosis, Differential ; Female ; Humans ; Mammography ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*pathology ; Ultrasonography, Mammary

BACKGROUNDAccurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant chemotherapy (NAC) include physical examination (PE), ultrasound (US), and magnetic resonance imaging (MRI). The purpose of this study was to evaluate the accuracy of PE, US, and MRI in predicting the response to NAC in patients with breast cancer.

METHODSAccording to the response evaluation criteria in solid tumors guidelines, the largest unidimensional measurement of the tumor diameter evaluated by PE, US, and MRI before and after NAC was classified into four grades, including clinical complete response, clinical partial response, clinical progressive disease, clinical stable disease, and compared with the final histopathological examination.

RESULTSOf the 64 patients who received NAC, the pathologic complete response (pCR) was shown in 13 of 64 patients (20%). The sensitivity of PE, US, and MRI in predicting the major pathologic response was 73%, 75%, and 80%, respectively, and the specificity was 45%, 50%, and 50% respectively. For predicting a pCR, the sensitivity of PE, US, and MRI was 46%, 46%, and 39%, respectively, and the specificity was 65%, 98%, and 92% respectively.

CONCLUSIONSCompared with final pathologic findings, all these three clinical and imaging modalities tended to obviously underestimate the pCR rate. A more appropriate, universal, and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.

Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Physical Examination ; Ultrasonography

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

OBJECTIVETo explore the presenting clinical features, management approach and treatment outcomes for occult breast cancer.

METHODSTwenty-three patients with occult breast cancer presenting with axillary nodal metastases treated in our department between 1986 and 2007 were included in this study. The clinicopathological, imaging and follow-up data of the 23 cases were retrospectively analyzed.

RESULTSAll patients were female. The mean age of diagnosis was 57.7 years with a range of 27 - 73 years. The mean follow-up was 15.70 months (range 1 - 62 months). Eight cases in 17 patients were positive by breast ultrasound, three cases in 9 patients were positive by mammography, one case in 2 patients was positive by breast MRI. 20 patients underwent modified radical mastectomy and three patients did not receive the mastectomy treatment. 16 patients had chemotherapy, four patients had radiotherapy, two patients had both chemotherapy and radiotherapy. Two patients had pulmonary metastasis, one patient had recurrence of axillary nodes, pulmonary metastasis and bone metastasis during follow-up.

CONCLUSIONSA normal check before operation to exclude a cancer of other origin can help to diagnose occult breast cancer. The breast must be treated. Axillary nodal dissection and mastectomy, or breast conservation with radiation therapy alone can be considered as a management option.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Neoplasms ; secondary ; Breast Neoplasms ; diagnosis ; pathology ; surgery ; therapy ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; surgery ; therapy ; Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; surgery ; therapy ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; secondary ; Lymph Node Excision ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Mammography ; Mastectomy, Modified Radical ; Middle Aged ; Radiotherapy, Adjuvant ; Retrospective Studies ; Ultrasonography, Mammary

OBJECTIVETo compare the efficiency of response evaluation by clinical examination, ultrasonograghy and mammography in neoadjuvant chemotherapy (NAC) for breast cancer.

METHODSA retrospective cohort study was conducted to analyze the data of 141 patients treated with neoadjuvant chemotherapy. Response evaluation was performed by clinical palpation, ultrasound and mammography.

RESULTSOnly 12 (8.5%) among the 141 patients presented with a stage I tumor. The tumor size determined by palpation was often larger than that by ultrasound before therapy (P < 0.01). Among patients with suspicions axillary nodes checked by ultrasound, 88.3% (53/60) of them had positive nodes by pathology before NAC, and 34.5% (10/29) of patients with negative nodes determined by ultrasound had positive nodes by pathology. In all the 141 patients, 21(14.9%) showed pathological complete remission in both the primary tumor and lymph node. For response evaluation, the false complete remission rate judged by clinical examination was 46.8% (22/47), and the false tumor residual rate by ultrasound was 84.0% (21/25). In 53.5% (23/43) of patients the response could not be assessed by mammography due to that the tumors were undistinguishable in size. The range of microcalcification was not reduced in 5 patients with a partial response of the tumor. 25 patients experienced needle puncture during therapy. Among them, in the 9 pathologically negative patients, only 3 achieved pCR, and the other 16 positive patients didn't achieve pCR.

CONCLUSIONUsing the puncture or sentinel lymph node biopsy, clinicians should pay enough emphasis on the pathological determination of the node status before chemotherapy. Clinicians will make a quite of false judgment of the tumor by clinical examination, ultrasound or mammography. They may use needle puncture during therapy to evaluate the response of neoadjuvant chemotherapy, and the result should be analyzed synthetically.

Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Cohort Studies ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Remission Induction ; methods ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Ultrasonography

Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.
Breast Neoplasms/pathology/surgery/therapy ; Carcinoma/*pathology/surgery/therapy ; Cervix Uteri/pathology/ultrasonography ; Charcoal/toxicity ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Granuloma/*diagnosis/pathology ; Humans ; Lymph Nodes/*surgery/ultrasonography ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

BACKGROUNDThere is an association between postmenopausal tamoxifen therapy and endometrial pathologies. We investigated the usefulness of diagnostic hysteroscopy and transvaginal ultrasonography (TVS) and estimated whether diagnostic hysteroscopy improves detection of endometrial pathologies in postmenopausal breast cancer patients on tamoxifen.

METHODSNinety-seven postmenopausal breast cancer patients who had been taking tamoxifen 20 mg/d for ≥ 6 months went through TVS, diagnostic hysteroscopy, and endometrial biopsy examinations. The presence of endometrial histopathologic features with abnormal TVS and diagnostic hysteroscopic findings were correlated.

RESULTSNo endometrial cancer was found in any of the 97 patients. Fifty-three patients (54.6%) developed endometrial polyps as diagnosed histopathologically. Fifty-nine patients (60.8%) tested positive in TVS exams, of whom 43 had polyps, four had hyperplasia, and 12 atrophy. Thirty-eight patients (39.2%) tested negative in TVS exams, of whom 10 had polyps, three hyperplasia, and 25 atrophy. TVS exams presented 63.6% specificity, 81.8% sensitivity, 72.9% positive-predictive value, and 73.7% negative-predictive value, whereas the corresponding values of diagnostic hysteroscopy were 100%, 98.1%, 100%, and 97.8% respectively. The correct ratio of hysteroscopy was significantly higher than that of TVS (P = 0.000).

CONCLUSIONSIn postmenopausal breast cancer patients treated with tamoxifen, TVS alone is not sufficient for the detection of endometrial pathologies. Additional use of diagnostic hysteroscopy considerably improves the detection of polyps, thus significantly reducing the rate of false-negative findings of endometrial pathologies.

Adult ; Aged ; Antineoplastic Agents, Hormonal ; adverse effects ; therapeutic use ; Breast Neoplasms ; drug therapy ; Endometrium ; diagnostic imaging ; pathology ; Female ; Humans ; Hysteroscopy ; methods ; Middle Aged ; Postmenopause ; Tamoxifen ; adverse effects ; therapeutic use ; Ultrasonography

Primary small cell carcinoma (SCC) of the breast, an exceedingly rare and aggressive tumor, is often characterized by rapid progression and poor prognosis. We report a case of primary SCC of the breast that was diagnosed through pathologic and immunohistochemical examinations. Computed tomography (CT) scans failed to reveal a non-mammary primary site. Due to the scant number of relevant case summaries, this type of tumor is proved to be a diagnostic and therapeutic challenge. Therefore, we also reviewed relevant literature to share expertise in diagnosis, clinicopathologic characteristics, treatment, and prognosis of this type of tumor. Future studies with more cases are required to define more appropriate treatment indications for this disease.
Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; CD56 Antigen ; metabolism ; Carboplatin ; administration & dosage ; Carcinoma, Intraductal, Noninfiltrating ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; Carcinoma, Small Cell ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Mammography ; Nuclear Proteins ; metabolism ; Phosphopyruvate Hydratase ; metabolism ; Synaptophysin ; metabolism ; Taxoids ; administration & dosage ; Thyroid Nuclear Factor 1 ; Transcription Factors ; metabolism ; Ultrasonography