This report describes a case of a 40-year-old female patient with concurrent invasive ductal carcinoma of the breast and malignant follicular lymphoma, initially suspected to be metastatic breast cancer. During the initial evaluation of invasive ductal carcinoma of right breast, multiple lymphadenopathies were noted throughout the body on ultrasonography and positron emission tomography/computed tomography images. Clinically, metastatic breast cancer was suggested, and the patient was administered chemotherapy, including hormonal therapy. The breast cancer improved slightly, but the lymphadenopathies progressed and excisional biopsy of a cervical lymph node revealed malignant follicular lymphoma.
Adult ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal* ; Drug Therapy ; Electrons ; Female ; Humans ; Lymph Nodes ; Lymphoma, Follicular* ; Ultrasonography

Breast cancer is the most common primary source of orbital metastasis. Metastasis occurs through hematogenous spread and predominantly involves the choroid. We present a case of a metastatic subconjunctival mass associated with primary breast cancer. To our knowledge, this is the first reported case of its kind. A 41-year-old woman presented with complaints of conjunctival injection and a foreign body sensation in the left eye. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Slit-lamp examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels. An excisional biopsy revealed a poorly differentiated adenocarcinoma. Positron emission tomography examination for systemic malignancy revealed multiple systemic metastasis. Metastatic disease should be considered in the differential diagnosis of subconjunctival lesions, and ophthalmic manifestations can play an important role in the detection of metastatic spread of a known primary breast cancer.
Adenocarcinoma ; Adult ; Biopsy ; Breast Neoplasms* ; Breast* ; Choroid ; Conjunctiva ; Conjunctival Neoplasms ; Diagnosis, Differential ; Drug Therapy ; Female ; Foreign Bodies ; Humans ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Orbit ; Positron-Emission Tomography ; Radiotherapy, Adjuvant ; Sensation

Whole-body bone scans and whole body 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic scans are sensitive for detecting bone metastasis in patients with breast cancer. However, it is often difficult to discriminate between bone metastasis and other nonmalignant bone lesions. Polyostotic fibrous dysplasia is a rare disorder characterized by the osteoid medullary cavity filling with fibrous tissue causing bony expansion. We report the case of a 42-year-old female patient with ductal carcinoma in situ, which appeared to have multiple bone metastases on initial work-up images. Subsequently, the bone metastases were identified as polyostotic fibrous dysplasia. The patient underwent modified radical mastectomy and subsequently visited for a second opinion regarding the bony metastases. She underwent right ilium computed tomography-guided biopsy. Pathology was consistent with fibrous dysplasia. This patient received only adjuvant tamoxifen, and 1.5 years later, there was no evidence of recurrence.
Adult ; Biopsy ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Electrons ; Female ; Fibrous Dysplasia of Bone ; Fibrous Dysplasia, Polyostotic* ; Humans ; Ilium ; Mastectomy, Modified Radical ; Neoplasm Metastasis* ; Pathology ; Positron-Emission Tomography ; Recurrence ; Referral and Consultation ; Tamoxifen ; Whole Body Imaging

Inflammatory myofibroblastic tumor (IMT) is an uncommon, tumorlike lesion that occurs at a number of body sites. Although the lung is the best known and most commonly organ, IMT has been found in diverse extrapulmonary locations, including the breast.Despite the performance of breast biopsy, the finding of IMT of the breast is exceedingly rare. IMT is a benign lesion and excision is the treatment of choice, but there is a relatively high rate of recurrence. We describe here two cases of IMT of the breast that occurred in a 21-year-old woman and a 28-year-old woman.
Adult ; Biopsy ; Breast* ; Female ; Humans ; Lung ; Myofibroblasts* ; Recurrence ; Young Adult

Sparganosis is not a common disease. Uncooked snake or frog, infected water and fresh water fish are the usual important source of sparganosis. Most cases of sparganosis are found in subcutaneous or adipose tissue of the abdominal and thoracic wall, and also in the inguinal inguinal regions, but the lesions are rarely found in the breast. We experienced 2 cases of sparganosis in the breast of a 69-year-old female & in the breast of a 37-year-old female. Among them, the 37-year-old female had a history of drinking impure water. The diagnosis was confirmed by surgical excision of the mass, and the plain mammography showed the characteristic finding of an irregular shaped, heterogenous mass lesion. We report here on this case and we briefly review the related literature.
Adipose Tissue ; Adult ; Aged ; Breast ; Diagnosis ; Drinking ; Female ; Fresh Water ; Humans ; Mammography ; Snakes ; Sparganosis* ; Thoracic Wall ; Water

PURPOSE: A sufficient response rate and good compliance are both important for instituting chemotherapy to treat metastatic breast cancer. Effective oral chemotherapy regimens have long been studied to improve patients' compliance. 5'-Deoxy-5-fluorouridine (5'-DFUR) is a prodrug of 5-fluorouracil (5-FU), which is known to be converted by thymidine phosphorylase (dThdPase). A recent preclinical study revealed that cyclophosphamide (CPA) upregulated dThdPase activity and especially in tumor cells. The purpose of this study was to examine the efficacy of long-term administration of 5'-DFUR/CPA for the patients suffering with metastatic breast cancer. METHODS: Thirty four cases with metastatic breast cancer after curative surgery were enrolled in this study. All the patients had been previously exposed to standard chemotherapy such as CMF (CPA, methotrexate, and 5-FU) and CAF (CPA, doxorubicin, and 5-FU). All patients had distant metastasis such as in the bone, lung and liver. Daily treatment consisted of 5'-DFUR 800 mg and CPA 100 mg both were given orally. The treatment was continued for at least 24 weeks. RESULTS: The mean age was 49 years and the treatment period ranged from 24 to 60 weeks. The response rate was 35.3%, while it was 26.5% for the patients with stable disease. The mean time to tumor progression was 36 weeks. A significant decrease in pain occurred in twenty patients (69%) with bone metastasis. The frequent adverse effects were leukopenia (32.4%) and gastrointestinal symptoms (20.4%). There was significant correlation between the rate of side effects and the duration of medication (p=0.010). CONCLUSION: These findings show that oral administration of 5'-DFUR and CPA is well tolerated on an outpatient basis and it was proven to suppress tumor progression. So, an oral combination therapy with 5'-DFUR and CPA may be suitable for metastatic breast cancer.
Administration, Oral ; Breast Neoplasms* ; Breast* ; Compliance ; Cyclophosphamide* ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil ; Humans ; Leukopenia ; Liver ; Lung ; Methotrexate ; Neoplasm Metastasis ; Outpatients ; Thymidine Phosphorylase

PURPOSE: The locoregional recurrence (LRR) in breast cancer, without distant metastasis has traditionally been regarded as a predictor of subsequent distant metastasis. This study was designed to attain the survival rate, disease progress in patients with a LRR only and to approve a locoregional treatment able to increase the survival in specific locoregional recurrent breast cancer. METHODS: The records of 223 patients with LRR, after initial treatment at the Asan Medical Center, between 1989 and 2003, were retrospectively reviewed. The patients were classified into the LRR only and simultaneous distant metastasis groups with the LRR group subdivided into the operable and inoperable groups. The data were analyzed using SPSS 11.0. RESULTS: There were 152 and 71 patients in the LRR only and simultaneous distant metastasis groups respectively: 105 patients in the LRR only group were operable cases. The 5-year survival rate of LRR was 42.5%, but this was 50.1% in the LRR only group. The 5-year survival rates following a recurrence in the operable and inoperable groups were 66.2% and 21.1%. On multivariate analysis, age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. The operable group indicated less tumor size at the primary surgery, less lymph node metastasis and more chest wall or axillary lymph node recurrences, compared to the inoperable group. CONCLUSION: In some of the LRR only cases, the survival rate was relatively good, especially in the operable group. Age at the primary surgery, tumor size, hormone receptor status and DFI were independent prognostic factors for survival. Surgical treatment could be resulted in good responses to the LRR patients with early stage or chest wall or axillary recurrences.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Survival Rate ; Thoracic Wall

PURPOSE: Radio-guided sentinel node biopsy has become a standard method for evaluating the axillary status. However, there is no guideline for the optimum extent of sentinel lymphadenectomy. The object of this study was to assess the probability of metastases according to the sequence of radioactivity in the sentinel nodes and to determine the accuracy of the methods for evaluating metastases. METHODS: 80 consenting patients underwent sentinel lymph node biopsy using 99mTc-phytate. All the lymph nodes that showed radioactivity higher than surroundings were excised and labeled as SN1 to SN5 according to the sequential radioactivity. All the excised sentinel nodes were evaluated by frozen sectioning (FS) and permanent sectioning (PS). The sensitivity, specificity, negative predictive value and accuracy of the procedure were then analyzed according to the evaluation method. RESULTS: All 80 patients showed a variable number of axillary sentinel node sites (SN1-SN5) and 19 patients (23.8%) had three or more sentinel node sites, with an average number of 1.98. The sensitivity, specificity, NPV and accuracy were higher on PS (94.4%, 100%, 98.4% and 98.8% respectively) than on FS (88.9%, 100%, 96.9% and 97.5% respectively). 20 patients were found to have metastatic breast cancer within the sentinel lymph nodes by IHC, but one case of a metastatic, non-sentinel node was found in the 60 patients with negative sentinel nodes, so that the final false negative rate was 4.8%. In 18 of the 20 sentinel node-positive patients(90.0%), the most radioactive lymph node (SN1) was a positive node. The removal of the most radioactive sentinel node and the 2nd most radioactive sentinel node accurately staged all 20 sentinel node-positive patients. CONCLUSION: Careful evaluation of the sentinel nodes with FS, PS and IHC study is essential to reduce the false negative results. In addition, excision of the highest and the 2nd highest lymph nodes is essential and the excision of the 3rd highest node if any, should also be considered for obtaining a better treatment results.
Biopsy* ; Breast Neoplasms* ; Breast* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Radioactivity* ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy

PURPOSE: The sentinel lymph node biopsy (SLNB) has revolutionized the management of breast cancer. Since October 1995, when we first applied the SLNB for treatment of breast cancer, it has quickly become the standard of care for the management of breast cancer in Korea. Herein we provide preliminary nation-wide data on the use of SLNB. METHODS: 51 breast surgeons at 47 hospitals throughout Korea were surveyed and 33 breast surgeons answered. Questionnaires including 20 items were used to solicit information on the indications, methods, application patterns of SLNB, including the other surgical issues. The answers from 33 breast surgeons were used for the analysis. RESULTS: Twenty-six of the 33 surgeons were applying SLNB for breast cancer. 11 surgeons have been applying SLNB more than 2 years. The most common indications for the SLNB were (1) no suggested axillary lymph node metastasis and (2) tumor size less than 3 cm. According to the detection methods, radioisotope tracer only was used in 38.5%, dye only in 26.9% and combination of radioisotope trace with dye in 34.6%. The most preferred dye was isosulfan blue followed by methylene blue. The most preferred radioisotope tracers were 99mTc-tin colloid and 99mTc-antimony. The most favorable injection site was subareolar area. Most surgeons performed frozen section biopsies after SLNB. Many surgeons agreed to accreditation after 20 learning cases. CONCLUSION: SLNB becomes the standard of treatments for breast cancer in Korea. A systematic education program for SLNB is required.
Accreditation ; Biopsy ; Breast Neoplasms ; Breast* ; Colloids ; Education ; Frozen Sections ; Korea ; Learning ; Lymph Nodes ; Methylene Blue ; Neoplasm Metastasis ; Sentinel Lymph Node Biopsy* ; Standard of Care ; Surveys and Questionnaires

PURPOSE: Angiogenesis plays a key role in the growth and metastasis of malignant tumor. Angiogenesis is reportedly enhanced by prostaglandins (PGs). Cyclooxygenase (COX)-2 is an inducible enzyme that catalyzes the formation of PGs from arachidonic acid. The COX enzyme system is composed of two isoenzymes, COX-1 and COX-2. Recent sources of experimental and epidemiological evidence suggest a significant role for the COX enzymes, particularly COX-2, in the pathogenesis of breast cancer. COX-2 overexpression in a murine mammary gland is sufficient to cause tumor formation. We performed our study to determine the effect of COX-2 inhibitor in a in vivo mouse mammary tumor (MMT) cell line. METHODS: In order to test our study, 24 C57BL/6 type mice (Jackson Laboratory, Bar Harbor, USA) were randomized to receive 35 days of either placebo supplemented diet (n=11) or a 1,500ppm celecoxib (CELEBREX, Pfizer Inc. St. Louis, USA) supplemented diet (n=13) beginning at day 0. At 14 days after the beginning day, 30 microliter of a 1% India ink solution that contained 500,000 of MMT cells or dye alone (control) was intradermally inoculated at each flank (day 14). The animals were sacrificed 21 days later (day 35) and skin specimens were harvested/processed for quantification of the microvessel density (MVD) that was associated with each inoculated site. The aortas that were isolated according to each treatment group at the time of animal sacrifice were used to create identical aortic ring angiogenesis assays (media 199 supplemented with 20% FBS). Explants were evaluated for 14 days in culture to determine both the rate of angiogenesis initiation (% of explants exhibiting the angiogenic phenotype) and the neovessel growth rate (using a subjective angiogenic index score for the wells exhibiting initiation). Analysis of variance (ANOVA) was used to evaluate the differences between groups for each assay. RESULTS: According to the immunohistochemical staining, celecoxib administration resulted in a parallel decrease in the MVD at both the control and MMT inoculated sites (22% and 21%, p = 0.025 and p = 0.010 respectively). On the aortic ring assay, the dietary treatment group was not significantly inhibited compared with the placebo group (75% and 63.3%, respectively, p = NS). However, dietary celecoxib administration significantly inhibited the angiogenic index of the neovessel growth rate (5.0 +/- 2.38 and 8.9 +/- 3.44, respectively, p < 0.001). CONCLUSION: These results suggest that a selective COX-2 inhibitor had an antiangiogenic effect on the in vivo tumor cells. We will perform more investigations of a selective COX-2 inhibitors, and these may will be crucial drugs to use as new chemotherapy agents for treating in cancer.
Animals ; Aorta ; Arachidonic Acid ; Breast Neoplasms ; Celecoxib ; Cell Line ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2* ; Diet ; Drug Therapy ; India ; Ink ; Isoenzymes ; Mammary Glands, Human ; Mice* ; Microvessels ; Neoplasm Metastasis ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Skin