PURPOSE: Gynecomastia can cause severe emotional phobia for breast cancer in elderly male and physical distress in young men. To select the appropriate cosmetic surgical approach for gynecomastia, I evaluated the usefulness of performing ultrasound-guided vacuum-assisted device excision of it. METHODS: Twenty-two cases of gynecomastia in 18 male were treated by vacuum-assisted biopsy device excision from November 2005 to June 2007. Their age range was 14-72 years old (mean, 34). The vacuum-assisted biopsy device excision was performed by 11G needle in 7 cases and 8G needle in 15 cases. I checked the number of extracted tissue pieces, the duration time of the procedure, immediate complications, and breast ultrasound after 3 months. RESULTS: The mean number of extracted tissue pieces was 69, and the average procedure duration was 25 minutes. There were no significant immediate complications such as bleedings and skin necrosis, and there were no clinically serious complications on 3 months follow-up examinations. During operation under local anesthesia, all patients tolerated the procedure. After vacuum-assisted biopsy device procedure, the cosmetic results were good to excellent for all the patients. CONCLUSION: Vacuum-assisted biopsy device excision was an effective surgical option, especially for small and glandular gynecomastia. I suggest this is a useful alternative procedure to surgery and liposuction, or it could be used effectively as a co-operative procedure with liposuction.
Aged ; Anesthesia, Local ; Biopsy ; Breast ; Breast Neoplasms ; Cosmetics ; Follow-Up Studies ; Gynecomastia ; Humans ; Lipectomy ; Male ; Necrosis ; Needles ; Phobic Disorders ; Skin

PURPOSE: This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia. METHODS: From January 2003 to June 2005, 54 surgically proven mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features. RESULTS: Of the 54 lesions, 46 lesions were benign and eight lesions were malignant. Benign lesions included an inflammatory change (n=7), ductal epithelial hyperplasia (n=7), fibrocystic change (n=18), intraductal papilloma (n=11), atypical ductal hyperplasia (n=2) and sclerosing adenosis (n=1). Malignant lesions included ductal carcinoma in situ (DCIS) (n=6), infiltrating ductal carcinoma (n=1) and mucinous carcinoma (n=1). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia. CONCLUSION: For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.
Adenocarcinoma, Mucinous ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Dilatation, Pathologic ; Hyperplasia ; Papilloma, Intraductal ; Ultrasonography, Mammary

PURPOSE: To reduce the side effects and improve the effectiveness of standard chemoradiation therapy, many complementary or alternative medicines have been tried. However, little is known about its immunologic effects in breast cancer patients. The aim of this study was to assess the immunologic effects of mistletoe extract (Viscum album L., VAE) in patients with early breast cancer after surgery followed by standard adjuvant chemoradiation therapy. METHODS: A total 20 patients with early breast cancer treated with breast conserving surgery followed conventional chemoradiation therapy. Ten of these patients received subcutaneous injections of VAE for 7 weeks. IL-2, IL-4, IL-6, IL-10, TGF-beta, and IFN-gamma levels in serum samples were measured in all patients. RESULTS: The concentrations of IL-2, IL-4, IL-10, and TGF-beta were not significantly changed between before and after VAE treatment in both test and control group. The concentration of IL-6 in the test group was increased from 8.19+/-1.75 pg/mL to 9.86+/-1.46 pg/mL after treatment (p=0.013). The concentration of IFN-gamma in the test group was remarkably increased from 91.76+/-17.16 pg/mL to 167.42+/-66.61 pg/mL after treatment (p=0.009). CONCLUSION: Significant increases in the concentration of IL-6 and IFN-gamma were observed after VAE treatment. These results suggest that VAE treatment can stimulate immune responses, especially cell-mediated immunity in immune-compromised patients received the chemoradiation for breast cancer.
Breast ; Breast Neoplasms ; Humans ; Immunity, Cellular ; Injections, Subcutaneous ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Mastectomy, Segmental ; Mistletoe ; Transforming Growth Factor beta

Recent studies of immune responses to pathogens have identified pathogen-associated molecular patterns recognized by the innate immune system through specialized receptors called toll-like receptors (TLRs). Signaling through these receptors initiates robust immune responses. By exploiting TLR signaling pathways, immunity to tumor-associated antigens may be generated. Many tumor-associated antigens are involved in the regulation of tumor phenotype or carcinogenesis. Immune targeting of these antigens may either alter the tumor phenotype, yielding a more treatable tumor, or eradicate early tumor stem cells preventing tumor formation. The oncoprotein HER2/neu, which is often overexpressed in ductal carcinoma in situ (DCIS), may provide such a target. Immune responses directed against HER2/neu may eliminate the disease, make tumors more amenable to anti-estrogen therapy, or prevent escape of hormone-resistant tumor phenotypes. Effective breast cancer prevention in preclinical studies utilizing murine HER2/neu transgenic models has stimulated interest in, and optimism regarding, protective breast cancer vaccines in humans. Induction of anti-HER2 neu T cell (CD4+ and CD8+) and B cell responses has been demonstrated in an ongoing clinical study targeting HER2/neu using a TLR agonist-primed dendritic cell vaccine. Moreover, these vaccinations lead to reductions in both HER2/neu expression and extent of DCIS. HER2/neu expression and aromatase activity have recently been linked through the intermediary cyclooxygenase 2 (COX-2). This convergence between growth factor and hormone mediated pathways provides additional support for the notion that a significant number of breast cancers may be prevented through effective immune targeting of HER2/neu. As progress is made towards the development of vaccines for breast cancer prevention, the contributions of immune-mediated effecter and inhibitory mechanisms to the pathogenesis of HER2/neu overexpressing breast cancer will need to be better understood.
Aromatase ; Breast ; Breast Neoplasms ; Cancer Vaccines ; Carcinoma, Intraductal, Noninfiltrating ; Cyclooxygenase 2 ; Dendritic Cells ; Humans ; Immune System ; Neoplastic Stem Cells ; Phenotype ; Toll-Like Receptors ; United Nations ; Vaccination ; Vaccines

No abstract available.
Breast ; Korea

We report her on a case of adenoid cystic carcinoma (ACC) associated with adenomyoepithelioma of the breast in a 73-year-old woman. ACC accounts for about 0.1% of all breast cancers. The patient presented with a large, nodular, rubbery mass that measured 5.5x4.0 cm in the subareolar region of the left breast. Light microscopy revealed various growth patterns of ACC with the adenomyoepitheli oma. Immunohistochemically, the epithelial cells in the ACC component reacted strongly for cytokeratin. The myoepithelial cells stained for smooth muscle actin, vimentin and S-100 protein, whereas staining for cytokeratin was weak. The adeno myoepithelioma component showed a similar staining pattern. Reactivity for both estrogen receptor (ER) and progesterone receptor (PR) were negative. There seems to be a spectrum of adeno myoepithelioma-related epithelial and myoepithelial lesions that ranges from low grade to high grade. Therefore, we suggest the present case of ACC arose from an adenomyoepithelioma or there is a close relationship among these combined epithelial and myoepithelial tumors. For both mammary ACC and adenomyoepitheliomas, complete excision with a margin of uninvolved tissue is the recommended treatment. Most of these patients will have an excellent prognosis.
Actins ; Adenoids* ; Adenomyoepithelioma* ; Aged ; Breast Neoplasms ; Breast* ; Carcinoma, Adenoid Cystic* ; Epithelial Cells ; Estrogens ; Female ; Humans ; Keratins ; Microscopy ; Muscle, Smooth ; Myoepithelioma ; Prognosis ; Receptors, Progesterone ; S100 Proteins ; Vimentin

PURPOSE: We wished to evaluate the prevalence and clinical features of axillary web syndrome (AWS) after sentinel node biopsy (SNB) and axillary lymph node dissection (ALND) during the conservative treatment of early breast cancer. METHODS: From March to November 2003, a total of 110 consecutive patients with clinical T1-T2 breast cancer underwent breast conserving surgery, with ALND being performed in 98 patients or SNB being performed in 12 patients. The diagnostic criterion for AWS was the presence of palpable and visible cords of tissue in the axilla upon maximal shoulder abduction. The extent of AWS was evaluated by inspection and by palpation of the axilla and the arm. RESULTS: Ten of 110 patients (9%) developed AWS. The AWS typically presented in the first several weeks after surgery and it resolved within 1 month of onset for all the patients. AWS was encountered for 3 patients (25%) among the patients who had SNB and for 7 patients (8%) among the ALND group, which is not statistically significant. Typically, the syndrome was self-limiting, and it resolved without any specific treatment. CONCLUSION: AWS is a significant cause of morbidity in the early postoperative period for 9% of the patients after axillary surgery. A more limited axillary surgery might help reduce the incidence and severity of the AWS.
Arm ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Node Excision* ; Lymph Nodes* ; Mastectomy, Segmental ; Palpation ; Postoperative Period ; Prevalence ; Shoulder

PURPOSE: Women with huge breasts suffer cervical, shoulder and back pain, breast pain and limitations of their daily activities, and all of this can create a functional disability and poor quality of life. Many patients with huge breasts need a reduction surgery not only for cosmetic purposes but also for functional improvement. METHODS: Fifty reduction mammoplasty cases that were operated in M.D. Clinic from April 2001 to August 2004 were retrospectively reviewed. Patient's age, the amount of removed breast tissue and the method of operation were evaluated, and 38 of these cases were surveyed by phone concerning the changes of their physical symptoms. RESULTS: The mean age of the cases were 37.3, and the ages ranged from 18 to 57. The amounts of removed tissue ranged from 50 g to 605 g (mean of right side: 275 g, and left side: 271 g). Nine cases of Benneli's circumareolar scar technique, 9 cases of inferior pedicle flap (inverted T scar) and 32 cases of circumvertical bipedicle flap were performed. Among the 38 cases that were surveyed by phone, most of them had suffered physical symptoms preoperatively, including cervical and shoulder pain (31 cases, 81.6%), back pain (35 cases, 92%), breast pain (21 cases, 55.3%), submammary rash (24 cases, 63.2%), fatigue (14 cases, 36.8%), headache (15 cases, 39.5%), numbness in hands (6 cases, 15.8%) and depression or nervousness (29 cases, 76.3%). The majority of survey respondents reported improvement in cervical and shoulder pain (100%), back pain (100%), fatigue (100%), headache (100%), breast pain (90.5%), submammary rash (91.7%), depression or nervousness (82.7%). Furthermore, there were additional gains including increased ability to enjoy physical exercise and social activity, improvement in the fit of their clothing and in their self-esteem. Adverse sequelae included scars (21 cases, 55.2%), asymmetry (11 cases, 28.9%), decrease in nipple sensation (13 cases, 34.2%), infection (1 cases, 2.6%) and hematoma (1 cases, 2.6%). CONCLUSION: Huge breast create physical symptoms including cervical and shoulder pain, back pain, breast pain, submammary rash, and other social and psychological problems. Reduction mammoplasty can improve the majority of these symptoms caused by huge breast, and this is an operation to help mend a functional disability.
Anxiety ; Back Pain ; Breast ; Cicatrix ; Clothing ; Surveys and Questionnaires ; Depression ; Exanthema ; Exercise ; Fatigue ; Female ; Hand ; Headache ; Hematoma ; Humans ; Hypesthesia ; Mammaplasty* ; Mastodynia ; Nipples ; Quality of Life* ; Retrospective Studies ; Sensation ; Shoulder ; Shoulder Pain

PURPOSE: Whole breast irradiation (WBI) after breast conserving surgery (BCS) is the standard treatment modality for controlling ipsilateral local recurrence of breast cancer. However, the WBI needs 5 to 6 weeks of the treatment period. Partial breast irradiation (PBI) has recently appeared as an alternative treatment to WBI in selected early breast cancer patients. This study was performed to evaluate the feasibility of PBI alone after BCS. METHODS: The brachy-catheters were inserted at the lumpectomy site after BCS. Six to nine days after the operation, the patients underwent fractionated PBI twice in a day with median dose of 3 Gy. The median value of the total dose was 3,120 cGy (28 to 34 Gy) given over 5 days. Forty-one patients who were proven as having a tumor-free margin by pathologic report were included in this study. Thirty-five patients had axillary lymph node-negative disease and thirty- six patients underwent concurrent adjuvant CMF chemotherapy. Follow-up ultrasono graphy was performed one month after the completion of PBI. RESULTS: The median post-operative hospital stay was 15 days (range: 12-17 days). Twenty-eight patients had seromas smaller than 1 cm in size and the 13 patients appeared to have 1~3 cm sized seromas on the follow-up ultrasonography. Long lasting (> 3 months) seromas were observed in 7 patients. None of the patients complained of tenderness or discomfort of the operation site and complications such as skin desquamation, pigmentation and wound contracture were not observed. Fat necrosis was observed in 1 patient. There was no case of local recurrence at the median follow-up period of 19 months (range: 15-41 months). CONCLUSION: PBI for early breast cancer using interstitial brachytherapy was a safe and effective alternative to WBI with excellent cosmetic results after BCS. The results of the current study prompts a multi-center clinical trial of PBI as an alternative to the WBI in early breast cancer to validate its feasibility in a selected patient population.
Brachytherapy ; Breast Neoplasms ; Breast* ; Contracture ; Drug Therapy ; Fat Necrosis ; Follow-Up Studies ; Humans ; Length of Stay ; Mastectomy, Segmental* ; Pigmentation ; Recurrence ; Seroma ; Skin ; Ultrasonography ; Wounds and Injuries

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis for early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10+LN). Breast cancer patients who had 10+LN clearly have a strikingly high risk of tumor recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients who had more than 10 positive axillary lymph nodes. METHODS: Of the 587 breast cancer patients who were operated on at Chungnam National University Hospital from February 1992 to November 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and the differences in survival according to the clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50+/-4 years. A mastectomy was done in 28 cases (90.3%), and a breast conserving operation was done in 3 cases (9.7%). The mean tumor size was 4.8+/-.5 cm. The mean number of removed axillary Lymph Nodes was 23.5+/-0.2 (range:10-52), and the mean number of positive axillary LNs was 20.0+/-10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 23 cases (69.6%) showed distant metastases as the first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up taking their adjuvant chemotherapy than for those patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in those patients who were treated using a combination chemotherapy with taxane plus cisplatin after their tumor recurrence. CONCLUSION: Breast cancer patients with 10+LNs have a strikingly high risk of tumor recurrence. Six cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of tumor recurrence. A combination chemotherapy with taxane and cisplatin was also a controllable variable for increasing survival after tumor recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence