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Contralateral Prophylactic Mastectomy and Prophylactic Salphingo-Oophorectomy in a BRCA1-Positive Breast Cancer Patient: A Case Report.

Ku Sang KIM ; Sairhee KIM ; Sang Ah HAN ; Eunyoung KANG ; Yong Tark JEON ; Tae Hyeon HA ; Chan Yeong HEO ; Mijung JANG ; Sun Mi KIM ; Jee Hyun KIM ; Kyu Eun LEE ; Sung Won KIM

Journal of Breast Cancer.2008;11(4):218-222. doi:10.4048/jbc.2008.11.4.218

Risk-reducing surgery is known as the most powerful preventive strategy for BRCA mutation carriers. This current case report represents the first documentation of the contralateral prophylactic mastectomy (CPM) and bilateral salphingo-oophorectomy (BSO) in a carrier of BRCA mutation in Korea. The patient was a 39-year-old woman who was seen in at a genetic counseling clinic for discussing of risk-reducing strategies for the breast and ovarian cancer. She presented at the age of 38 year with a 1.5 cm sized, grade 3, and ER/PR/HER2 negative infiltrating ductal carcinoma of the right breast. She was treated with wide local excision of the right breast and sentinel lymph node biopsy of the axilla. She was then treated with CAF (Cyclophosphamide+Doxorubicin+5-Fluorouracil) chemotherapy and radiation therapy. She was initially counseled at the time of surgery due to the family history of her mother, who suffered with breast cancer at the age of 58. After the completion of chemotherapy, we received the genetic test results and it was positive for the BRCA1 mutation (3746_3747insA). After a long discussion of cancer surveillance and risk-reducing options, she decided to undergo ipsilateral mastectomy and CPM and BSO. Before surgery, psychiatric consultation was done and questionnaires evaluating her depression, anxiety, body image, quality of life, and psychological distress were filled out. After discussion with the plastic surgeon, she decided to undergo delayed reconstruction of the breast. We performed endoscopic bilateral skin-sparing mastectomy and a laparoscopic bilateral salphingo-oophorectomy. There was no complication after surgery and the pathologic examination revealed no evidence of cancer in both breasts and ovaries. We think that CPM and BSO are feasible risk-reducing options for the breast cancer patients with the BRCA mutation in Korea.
Adult ; Anxiety ; Axilla ; Body Image ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Depression ; Female ; Genetic Counseling ; Humans ; Korea ; Mastectomy ; Mothers ; Nitriles ; Ovarian Neoplasms ; Ovary ; Pyrethrins ; Quality of Life ; Sentinel Lymph Node Biopsy ; Surveys and Questionnaires

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Malignant Fibrous Histiocytoma in the Breast: A Case Report.

Jong Kyung PARK ; Seung Hye CHOI ; Seong Keun KIM ; Sang Seob YUN ; Jong Min BAEK ; Young Jin SUH ; Woo Chan PARK ; Byung Joo SONG ; Se Jung OH ; Jeong Soo KIM ; Seong LEE ; Sang Seol JUNG ; Ki Ouk MIN ; Hyeon Sook KIM

Journal of Breast Cancer.2008;11(4):213-217. doi:10.4048/jbc.2008.11.4.213

Malignant fibrous histiocytoma is the most common form of soft tissue sarcoma during middle and late adulthood in the deep connective tissues of the extremities, abdominal cavity, and retroperitoneum. Primary breast sarcoma is a rare disease entity, comprising less than 1% of all breast malignancies. Malignant fibrous histiocytoma of the breast is very rare. We presented one case of a malignant fibrous histiocytoma of the right breast in a 49-year-old woman and report the case with a review of the literature.
Abdominal Cavity ; Breast ; Connective Tissue ; Extremities ; Female ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous ; Humans ; Middle Aged ; Rare Diseases ; Sarcoma

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Immediate Breast Reconstruction with Contralateral Pectoralis Major Myomammary Flap for Breast Conserving Surgery.

Seung Ju LEE ; Young Tae BAE ; Hyong Il SEO ; Tae Woo KANG

Journal of Breast Cancer.2008;11(4):206-212. doi:10.4048/jbc.2008.11.4.206

PURPOSE: There has been much reported data showing that breast reconstruction surgery does not result in reduced patient survival if the accepted principles of cancer surgery are closely followed. The proper reconstructive technique can be selected according to diverse factors, but breast size and the site of tumor are mostly important. The latissimus dorsi musculocutaneous flap (LDMCF) is one of the most commonly used techniques for early breast cancer patients who have small breasts. But, it has difficulties for supplying enough tissues to the widely excised tumor site. Especially for ptosis patients, reduction mammoplasty by itself is not enough to achieve symmetry of the breast. We suggest that the pectoralis major myomammary flap (PMMF) is a useful technique for the patients with ptosis. METHODS: Seventeen patients with ptosis were treated with breast conserving surgery with PMMF reconstruction. A quadrantectomy rather than lumpectomy was performed through a planned skin incision, and axillary lymph node dissection was performed according to the results of sentinel lymph node biopsy. The PMMF is carefully harvested without perforating branch injury to the internal thoracic artery. Reconstruction was done via the PMMF through the medial tunnel between both breasts. RESULTS: Among the seventeen patients, seroma occurred in two patients and no necrosis occurred at all. The cosmetic result was fair in 15 patients and poor in two patients, based on the four-point scoring system of breast cosmetics. CONCLUSION: After performing enough quadrantectomy to adhere to the accepted principles of cancer surgery, PMMF was quite useful to supply enough proper tissues for breast reconstructions, and especially for the ptosis patients.
Breast ; Breast Neoplasms ; Cosmetics ; Female ; Humans ; Lymph Node Excision ; Mammaplasty ; Mammary Arteries ; Mastectomy, Segmental ; Necrosis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy ; Seroma ; Skin

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Apocrine Carcinoma of the Breast: Clinicopathologic Analysis of 19 Cases.

Min Ki SUNG ; Woo Chul NOH ; Min Suk KIM ; Hyun Ah KIM ; Nam Sun PAIK ; Nan Mo MOON ; Yang Hee KIM

Journal of Breast Cancer.2008;11(4):201-205. doi:10.4048/jbc.2008.11.4.201

PURPOSE: Apocrine carcinoma of the breast, a specific histologic type of human breast cancer, is a rare malignant tumor. Because of the rarity of apocrine carcinoma and lack of a standardized definition, the clinicopathologic features have not been definitively determined. In this study, we present a single institution analysis of the clinicopathologic features of 19 cases of apocrine carcinoma and contrast them with those seen in infiltrating ductal carcinoma, not otherwise specified (NOS). METHODS: We respectively reviewed the records of 19 patients with apocrine carcinoma who underwent surgery at Korea Cancer Center Hospital between October 1997 and April 2007. RESULTS: The mean patient age was 52.8 years. Eight patients (42.1%) were under 50 years of age. In all patients, the initial symptom was a breast mass. Twelve (63.2%) of 19 tumors were located in the right breast and the other 7 cases (36.8%) were located in the left breast. The average tumor size was 2.19 cm (range 0.7-7 cm). Two patients had axillary lymph node metastasis. Estrogen receptor (ER) was positive in 3 cases (16.7%). The HER-2 overexpression rate was 35.3%. There was no locoreginal recurrence, distant metastasis, or death during the median follow-up period of 35.4 months (range 4-114 months). CONCLUSION: Compared with the alleged characteristics seen in Korean breast cancer patients, apocrine carcinoma was characterized by an older age at the time of diagnosis and a higher incidence of hormone receptor negatively. The HER-2 overexpression rate was similar to the rate for other tumors. Although there was a relatively low incidence ER positivity, there was no recurrence or death. Therefore, apocrine carcinoma appears to be clinically distinct from infiltrating ductal carcinoma, NOS.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence

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The Impact of the Ratio of Positive Nodes to Removed Nodes on Recurrence and Overall Survival in Node Positive Breast Cancer Patients.

Je Yeon KIM ; Hye In LIM ; Se Kyung LEE ; Jae Hyuck CHOI ; Wan Wook KIM ; Jun Ho CHOE ; Jung Han KIM ; Ji Su KIM ; Jeong Eon LEE ; Seok Jin NAM ; Jung Hyun YANG

Journal of Breast Cancer.2008;11(4):194-200. doi:10.4048/jbc.2008.11.4.194

PURPOSE: The status of axillary lymph node (LN) metastasis is the most important prognostic factor in breast cancer. Postoperative regional nodal radiotherapy is recommended usually based on the number of metastatic LNs, which is associated with the total number of removed LNs during the axillary dissection. We evaluated the prognostic impact of the ratio of metastatic LNs to removed LNs on disease free survival and overall survival in breast cancer patients. METHODS: The medical records of 743 breast cancer patients with metastatic axillary LNs and treated at Samsung Medical Center between 1994 and 2003 were retrospectively analyzed. The ratio of metastatic/removed LNs as well as the other prognostic factors were analyzed. RESULTS: Both disease-free survival and overall survival rates were significantly worse in patients with a ratio of metastatic/removed LNs greater than 20% compared to those patients with a ratio of less than 20% (p=0.028, p<0.001, respectively). In patients with T1-2 and N1 breast cancer, the ratio of metastatic/removed LNs greater than 20% was significantly associated with poorer disease-free survival (p=0.027). CONCLUSION: A ratio of metastatic/removed LNs greater than 20% in the axilla can be an adverse prognostic factor in breast cancer patients with axillary node metastasis. In T1-2 N1 breast cancer patients, adjuvant radiotherapy as well as more aggressive chemotherapy therapy may be indicated.
Axilla ; Breast ; Breast Neoplasms ; Disease-Free Survival ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate ; Sydnones

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The Prognostic Factors for Tumor Metastasis to Bone from Breast Cancer and Survival for Breast Cancer Patients after Bone Metastasis.

Sung Gui AHN ; Kyong Sik LEE ; Seung Il KIM

Journal of Breast Cancer.2008;11(4):187-193. doi:10.4048/jbc.2008.11.4.187

PURPOSE: Bone is the most common site of breast cancer metastasis. The aim of this study is to identify the subgroup of patients who have high risk of bone metastasis and we evaluate the prognostic factors of overall survival after bone relapse. METHODS: A total 2,785 of primary breast cancer patients who were treated from January 1980 to December 2001 were included in this analysis. All the patients received radical surgery at the time of diagnosis. We retrospectively collected the clinico-pathologic data (age, tumor size, axillary lymph node status, histologic grade, steroid hormone receptor status, and disease-free interval after primary surgery). Definitive radiologic evidence of bone metastases by plain X-ray or whole body bone scan during follow-up was defined as bone metastases. We analyzed the relationship between the clinicopatholgic factors and the risk of bone metastases and the overall survival after bone relapse. RESULTS: During follow-up, 256 patients (9.3%) experienced bone metastasis. By multivariate analysis using Cox's model, age less than 35 years (p<0.001, risk ratio [RR]; 2.467, 95% confidence interval [CI]; 1.619-3.759), large primary tumor more than 2 cm (p=0.005, RR; 1.911, 95% CI; 1.222-2.988), positive axillary node (p<0.001, RR; 2.798, 95% CI; 1.867-4.195), and a high histologic grade (p=0.046, RR; 1.631, 95% CI; 1.008-2.640) were significantly associated with frequent bone metastases. The 10 years survival rate after bone metastasis was 26.9%. Disease free interval less than 2 years (p<0.001, RR; 3.453, 95% CI; 2.382-5.005) and hormone receptor status (p=0.003, RR; 1.791, 95% CI; 1.218-2.635) were independently associated with poor overall survival after bone relapse. CONCLUSION: We concluded that a shorter disease-free interval after definitive surgery and hormonal receptor status of the primary tumor are independent prognostic factors of overall survival after bone metastasis. These results show that a tailored strategy is needed for the treatment of patients with bone metastases.
Breast ; Breast Neoplasms ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Odds Ratio ; Recurrence ; Retrospective Studies ; Survival Rate

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Breast Cancer Screening: A Medical Audit of the Screening Mammography Performed at One Institution for 10 Years.

Min Hee HUR ; Hae Kyung LEE ; Wan Nam KANG ; Chan Seok YOON ; Seung Sang KO ; Yu Jin LEE ; Kyung Sang LEE ; Byung Jae CHO ; Sung Soo KANG

Journal of Breast Cancer.2008;11(4):180-186. doi:10.4048/jbc.2008.11.4.180

PURPOSE: Screening for breast cancer has constantly been increasing since the benefit of screening for breast cancers was established. The purpose of this study was to investigate the efficacy of annual breast cancer screening at one institution for 10 years by conducting a medical audit. METHODS: From March 1995 to July 2004, we performed 110,588 annual clinical examinations and mammographies on 58,024 women, who wanted to undergo breast cancer screening. Two hundred fourteen breast cancers were detected during screening, and one hundred sixty one of these patients were operated on. We then compared these results with the ideal rates for medical audits. RESULTS: Of the 110,588 cases that were screened, the recall rate for further examination was 12.1% (n=13,423). The biopsy rate was 1.01% (n=1,116). Two hundred fourteen breast cancers were detected for a detection rate of 0.19%. The percent of stage 0 cancer among all the cancer was 23.6%, stage I was 40.4%, stage IIa was 19.9%, stage IIb and IIIa were a combined 6.2%, stage IIIc was 3.1%, and stage IV was 0.6%. The positive predictive value (PPV) based on the abnormal findings on the screening examinations was 1.6% (PPV1). The PPV when a biopsy or surgical consultation was recommended was 15.1% (PPV2). The percent of tumor found as stage 0 or I was 64% (103/161). The tumor found as minimal cancer (stage 0 or tumor lesser than 1 cm) was 38.5% (62/161). There were 38 cases of axillary lymph node metastasis (23.6%). The number of cases of cancers found per 1,000 cases was 1.7. The prevalence of cancer found per 1,000 first examinations was 2.3. The incidental cancer found per 1,000 follow-up examinations was 1.2. The recall rate for further evaluation was 12.1%. These results were compatible with the ideal rates for medical audits, except for the recall rate, the PPV1, the PPV2, and the cancers found per 1,000 cases. CONCLUSION: On the base of these results, breast cancer screening was properly performed in this institution. Breast cancer screening using a clinical examination and a mammography is effective for the early detection of breast cancer.
Biopsy ; Breast ; Breast Neoplasms ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mammography ; Mass Screening ; Medical Audit ; Neoplasm Metastasis ; Prevalence

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Expression of Cyclin D1 and bcl-2 in Infiltrative Ductal Carcinoma of the Breast: Their Correlations and Clinical implications.

Young Ki HONG ; Seung Sam BAIK ; Min Sung CHUNG ; Ho Sung YOON

Journal of Breast Cancer.2008;11(4):172-179. doi:10.4048/jbc.2008.11.4.172

PURPOSE: Cyclin D1 and bcl-2 are involved in cell proliferation and apoptosis in tumor development and are commonly expressed in breast cancer. But there are few clinical reports on the correlation between cyclin D1 and bcl-2 expression. This study was designed to analyze the correlations of cyclin D1 and bcl-2 and their clinical implications in breast cancer. METHODS: Immunohistochemical expression of cyclin D1 and bcl-2 were studied in 342 infiltrative ductal carcinoma cases and were compared with clinicopathologic parameters such as age, tumor size, histologic grade, lymph node status, p53, c-erbB2 and hormone receptors. RESULTS: Cyclin D1 expression was found in 86 of 342 cases (25.1%). Bcl-2 was positive in 227 of 342 cases (66.4%). Bcl-2 overexpression was associated with the high expression of cyclin D1 (p=0.001). Correlation was detected between both cyclin D1 and bcl-2 and hormone receptor positivity (p<0.001). There was a reverse correlation between bcl-2 and histologic grade, p53, c-erbB2. And the bcl-2 overexpression group showed better disease free survival rates at 3-year follow up. CONCLUSION: Higher expression of cyclin D1 was associated with bcl-2 overexpression. Positive estrogen receptor expression was associated with high cyclin D1 and bcl-2 expression. Bcl-2 tends to correlate with a positive clinical outcome.
Apoptosis ; Breast Neoplasms ; Carcinoma, Ductal ; Cell Proliferation ; Cyclin D1 ; Cyclins ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Lymph Nodes ; Prognosis

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The Expression of Heat Shock Protein 60 kDa in Tissues and Cell Lines of Breast Cancer.

Byung Chul YOU ; Seung Yeon PARK ; Young Don LEE ; Jung Nam LEE ; Yu Jin HWANG ; Heung Kyu PARK

Journal of Breast Cancer.2008;11(4):161-171. doi:10.4048/jbc.2008.11.4.161

PURPOSE: Breast cancer has been reported as the most common cancer of women in the United States, Western Europe and Korea and about 210,000 and 10,000 women in United States and Korea every year, respectively are diagnosed with it. Breast cancer is curable with an early diagnosis, and many researchers have made efforts to find a marker for this malady, heat shock protein (HSP) consists of 6 groups, it is highly preserved throughout both the prokaryotic and eukaryotic cells and it acts as a molecular chaperone that's involved in protein folding. HSPs have been recently reported to be related with breast cancer. In this study, we investigated the changes of expression of HSP60 in tissues and cell lines of breast cancer. METHODS: We obtained breast cancer tissues and normal tissues from breast cancer patients, and we purchased several cancer cell lines from American tissue culture correction. We treated the tissues and the cell lines of human breast cancer with heat shock protein. Proteins and mRNAs were isolated from the tissues and the cells and then we performed Western blotting, reverse transcriptase-Polymerase chain Reaction and fluorescence activated cell sorter analysis on them. RESULTS: On Western blot, HSP60 was more overexpressed in the tissues and the cell lines of breast cancer than in the normal breast tissues and cell lines. The expression of HSP60 showed 2 types of molecular weight differences in the tissues and cell lines of breast cancer, and specifically, low HSP60 was over-expressed in the cancer tissues. There was no difference between the breast cancer cell lines and the normal cell lines in the expressions of HSP60 mRNA, according to the treatment with heat shock. Also, there was no relationship between phosphorylation and the structural difference of HSP60 protein, according to HSP60 protein's molecular weight. The expression of HSP60 has been mostly reported at the mitochondria; however, in this study, it was more predominantly detected at the cytoplasm than at the mitochondria in the breast cancer cell lines. CONCLUSION: We conclude that HSP60 may be used as a diagnostic marker for breast cancer. Detailed investigation of the usefulness and significance of the HSP60 expression as a prognostic factor is required in further studies.
Blotting, Western ; Breast ; Breast Neoplasms ; Cell Line ; Chaperonin 60 ; Cytoplasm ; Early Diagnosis ; Eukaryotic Cells ; Europe ; Female ; Fibrinogen ; Fluorescence ; Heat-Shock Proteins ; Hot Temperature ; Humans ; Korea ; Mitochondria ; Molecular Chaperones ; Molecular Weight ; Phosphorylation ; Protein Folding ; Proteins ; RNA, Messenger ; Shock ; United States

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Painless Posterior Thigh Mass as a Presentation of Metastatic Breast Cancer.

Hyun Min CHO ; Myung Su KO ; Ji Hye LEE ; Won Sang JUNG ; Hyun Joo CHOI ; Se Jeong OH ; Young Jin SUH

Journal of Breast Cancer.2010;13(4):448-451. doi:10.4048/jbc.2010.13.4.448

Soft tissue metastasis clinically presenting as either painless subcutaneous or painful intramuscular nodules is extremely rare and may lead to an errant clinical suspicion of sarcoma. In general, most soft tissue metastasis comes from lung carcinoma; however, to date, there have been no reports of a posterior thigh mass just beneath the skin metastasizing from breast cancer. Here, we report a case of distant soft tissue metastasis presenting as a painless solitary left posterior thigh mass measuring 1.5 cm in diameter, which was later shown by positron emission tomography-computed tomography (PET-CT) to have multiple simultaneous mediastinal lymph node metastases. Eleven months ago, the patient had undergone curative breast-conserving surgery (BCS) for cancer of her left breast. At that time, her tumor showed a triple negative phenotype. Initial PET-CT right before the BCS had shown no metastasis. After histological and radiologic evaluation for the metastases, she decided to have systemic chemotherapy.
Breast ; Breast Neoplasms ; Electrons ; Humans ; Lung ; Lymph Nodes ; Mastectomy, Segmental ; Neoplasm Metastasis ; Phenotype ; Sarcoma ; Skin ; Thigh

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