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We report a rare case of intraductal lipid-rich carcinoma of the breast with a component of glycogen-rich carcinoma. An impalpable tumor that was revealed by mammography and magnetic resonance imaging was excised. Histologic examination showed vacuolated neoplastic cells in the mammary ducts, and electron microscopy confirmed lipid droplets in the cytoplasm. The coexistence of glycogen-rich carcinoma was shown. Lipid-rich carcinoma that is coexistent with glycogen-rich carcinoma is rare, and most lipid-rich carcinomas are invasive. Intraductal lipid-rich carcinoma is difficult to detect without echography or mammography.
Breast ; Cytoplasm ; Glycogen ; Immunohistochemistry ; Magnetic Resonance Imaging ; Mammography ; Microscopy, Electron

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Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management.

Jong Min BAEK ; Jin A LEE ; Yu Hee NAM ; Gi Young SUNG ; Do Sang LEE ; Jong Man WON

Journal of Breast Cancer.2012;15(1):133-134. doi:10.4048/jbc.2012.15.1.133

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.
Adult ; Axilla ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Chyle ; Drainage ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Modified Radical

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A Case Report of Breast Cancer with Extensive Pulmonary Lymphovascular Tumor Emboli.

Yaewon YANG ; Younak CHOI ; Seung Hoon BEOM ; Jin Won KIM ; Yoon Kyung JOEN ; Nam Joong KIM ; Joo Hyun KIM ; Seock Ah IM ; Kyung Hun LEE

Journal of Breast Cancer.2012;15(1):128-132. doi:10.4048/jbc.2012.15.1.128

We describe a patient with breast cancer who relapsed with an extensive pulmonary lymphovascular tumor embolism. A 38-year-old female, who previously received neoadjuvant chemotherapy and curative resection of breast cancer, underwent adjuvant chemotherapy and was referred to the emergency room because of sudden-onset pleuritic chest pain lasting for 10 days. Despite a trial of empirical antibiotics, the chest pain and the extent of consolidative lung lesion on chest radiographs rapidly aggravated. We performed an open lung biopsy to confirm the etiology. The histopathological review revealed a hemorrhagic infarction caused by lymphovascular tumor emboli from a metastatic breast carcinoma. Palliative first-line chemotherapy was administered, consisting of ixabepilone and capecitabine, and the lung lesion improved markedly.
Adult ; Anti-Bacterial Agents ; Biopsy ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Chest Pain ; Deoxycytidine ; Emergencies ; Epothilones ; Female ; Fluorouracil ; Humans ; Infarction ; Lung ; Neoplastic Cells, Circulating ; Thorax ; Capecitabine

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Primary Leiomyosarcoma of the Breast: A Case Report.

Zulfikar KARABULUT ; Hampar AKKAYA ; Gokhan MORAY

Journal of Breast Cancer.2012;15(1):124-127. doi:10.4048/jbc.2012.15.1.124

Primary leiomyosarcoma of the breast is an extremely rare tumor, accounting for less than 1% of all breast tumors and only 24 cases have been reported in the English medical journals. It is quite difficult to diagnose leiomyosarcoma preoperatively. Establishing an accurate diagnosis is very important in planning treatment. When preoperative diagnosis can be achieved before or during the operation, wide resection should be performed. There is no need for axillary lymph node dissection. In this case report, we present a case involving primary leiomysarcoma of the breast in a 48-year-old woman and we discuss optimal treatment options.
Accounting ; Breast ; Breast Neoplasms ; Female ; Humans ; Leiomyosarcoma ; Lymph Node Excision ; Mastectomy ; Middle Aged

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Medical and Surgical Treatment of Idiopathic Granulomatous Lobular Mastitis: A Benign Inflammatory Disease Mimicking Invasive Carcinoma.

Gunay GURLEYIK ; Ali AKTEKIN ; Fugen AKER ; Hikmet KARAGULLE ; Abdullah SAGLAMC

Journal of Breast Cancer.2012;15(1):119-123. doi:10.4048/jbc.2012.15.1.119

PURPOSE: Idiopathic granulomatous lobular mastitis (IGLM) is a rare chronic inflammatory disease of the breast with obscure etiology that mimics invasive carcinoma both clinically and radiologically. The treatment of IGLM remains controversial. The aim of proper management is to use a combination of medical and surgical treatment of this benign condition to achieve a good cosmetic result and low recurrence rate. METHODS: A retrospective analysis of 19 patients with IGLM is performed based on the findings of clinical, radiological, and pathological examinations. The results of two treatments are presented: medical treatment with oral corticosteroids, and consecutive surgical excision after a follow-up period of 20 months (range, 6-75 months). RESULTS: The majority of patients treated in this paper were young (mean, 34 years) parous women with a history of hormonal medication use. The main clinical finding is large, irregular, and painful mass. Hypoechoic lobulated, irregular tubular or oval shaped masses had been imaged by ultrasound. Mammographic findings were an ill-defined mass, enlarged axillary lymph nodes, asymmetric density, and architectural distortion. Diagnoses of IGLM had been established by cytological or histological examination. Symptoms subside and inflammatory changes regressed with medical treatment. The remaining lesions were excised by consecutive breast conserving surgery. The disease recurred in one patient during the follow-up period. CONCLUSION: IGLM is an inflammatory breast disease found in young women who present with a large painful irregular mass, which mimics carcinoma, as a physical change. Breast imaging modalities are not helpful to differentiate IGLM from invasive cancer. The correct diagnosis is established by cytological or histological examination. Medical treatment with corticosteroids provides significant regression of the inflammatory disease, allowing more conservative surgery. Consecutive surgical excision of the remaining lesions with good cosmetic results provides definitive treatment and reduces the risk of recurrence.
Adrenal Cortex Hormones ; Breast ; Breast Diseases ; Cosmetics ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mastectomy ; Mastectomy, Segmental ; Mastitis ; Recurrence ; Retrospective Studies

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Differential Diagnosis in Idiopathic Granulomatous Mastitis and Tuberculous Mastitis.

Hee Ri Na SEO ; Kuk Young NA ; Hyun Ee YIM ; Tae Hee KIM ; Doo Kyoung KANG ; Ki Keun OH ; Seok Yun KANG ; Young Sil AN ; Mison CHUN ; Woojae KIM ; Rae Woong PARK ; Yong Sik JUNG ; Ku Sang KIM

Journal of Breast Cancer.2012;15(1):111-118. doi:10.4048/jbc.2012.15.1.111

PURPOSE: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of unknown etiology. The diagnosis of IGM requires that other granulomatous lesions in the breast be excluded. Tuberculous mastitis (TM) is also an uncommon disease that is often difficult to differentiate from IGM. The purpose of this study is to develop a new algorithm for the differential diagnosis and treatment of IGM and TM. METHODS: Medical records of 68 patients (58 with IGM and 10 with TM) between July 1999 and February 2009 were retrospectively reviewed. RESULTS: The mean age of the patients was 33.5 (IGM) and 40 (TM) years (p=0.018). The median follow-up was 84 months. Of the total 10 patients with TM, 5 patients had a history of pulmonary tuberculosis. The most common symptoms of the diseases were breast lump and pain. However, axillary lymphadenopathy was more seen in TM (50%) compared to IGM (20.6%) (p=0.048). TM showed more cancer-mimicking findings on radiologic study (p=0.028). In IGM, 48 patients (82.7%) underwent surgical wide excision and 21 patients (36.2%) were managed with corticosteroid therapy and antibiotics. All of the TM patients received anti-tuberculosis medications and 9 patients (90%) underwent wide excision. The mean treatment duration was 2.8 months in IGM and 8.4 months in TM. Recurrence developed in 5 patients (8.6%) in IGM and 1 patient (10%) in TM. CONCLUSION: This study shows different characteristics between IGM and TM. The IGM patients were younger and had more mastalgia symptoms than the TM patients. Axillary lymphadenopathy was seen more often in TM patients. Half of the TM patients had pulmonary tuberculosis or tuberculosis lymphadenitis. Surgical wide excision might be both therapeutic and useful for providing an exact diagnosis.
Anti-Bacterial Agents ; Breast ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Immunoglobulin M ; Lymphadenitis ; Lymphatic Diseases ; Mastitis ; Mastodynia ; Medical Records ; Recurrence ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary

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Dose-Volume Analysis of Lung and Heart according to Respiration in Breast Cancer Patients Treated with Breast Conserving Surgery.

Jae Goo SHIM ; Jeong Koo KIM ; Won PARK ; Jeong Min SEO ; Chae Sun HONG ; Ki Won SONG ; Cheong Hwan LIM ; Hong Ryang JUNG ; Chan Hyeong KIM

Journal of Breast Cancer.2012;15(1):105-110. doi:10.4048/jbc.2012.15.1.105

PURPOSE: Adjuvant radiotherapy of breast cancer using a photon tangential field incurs a risk of late heart and lung toxicity. The use of free breathing (FB), expiration breath hold (EBH), and deep inspiration breath hold (DIBH) during tangential breast radiotherapy as a means of reducing irradiated lung and heart volume was evaluated. METHODS: In 10 women with left-sided breast cancer (mean age, 44 years) post-operative computed tomography (CT) scanning was done under different respiratory conditions using FB, EBH, and DIBH in 3 CT scans. For each scan, an optimized radiotherapy plan was designed with 6 MV photon tangential fields encompassing the clinical target volume after breast-conserving surgery. RESULTS: The results of dose-volume histograms were compared using three breathing pattern techniques for the irradiated volume and dose to the heart. A significant reduction dose to the irradiated heart volume for the DIBH breathing technique was compared to FB and EBH breathing techniques (p<0.05). CONCLUSION: This study demonstrated that the irradiated heart volume can be significantly reduced in patients with left-sided breast cancer using the DIBH breathing technique for tangential radiotherapy.
Breast ; Breast Neoplasms ; Cardiac Volume ; Female ; Heart ; Humans ; Lung ; Mastectomy, Segmental ; Radiotherapy, Adjuvant ; Respiration

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Long-Term Outcome of Internal Mammary Lymph Node Detected by Lymphoscintigraphy in Early Breast Cancer.

Min Young KOO ; Se Kyung LEE ; Soo Youn BAE ; Min Young CHOI ; Dong Hui CHO ; Sangmin KIM ; Jeong Eon LEE ; Seok Jin NAM ; Jung Hyun YANG

Journal of Breast Cancer.2012;15(1):98-104. doi:10.4048/jbc.2012.15.1.98

PURPOSE: Internal mammary lymph node (IMLN) metastasis is an important prognostic indicator in breast cancer. However, the necessity of internal mammary sentinel lymph node biopsy for accurate staging, for choosing adjuvant treatment, and as a prognostic indicator, has remained controversial. METHODS: From January 2001 to December 2006, 525 female breast cancer patients underwent radical surgery after preoperative lymphatic scintigraphy. We retrospectively analyzed the follow-up results, recurrences, and deaths of all patients. RESULTS: There was no significant difference in the clinicopathological characteristics between the axilla and the IMLN groups. The median follow-up period was 118.8 months (range, 7-122 months) in the axilla group and 107.7 months (range, 14-108 months) in the IMLN group. During the median follow-up period, the breast cancer-related death rate in the axilla group was 3.6%, which was not significantly different from that of the IMLN group (1.3%) (p=0.484). The five-year survival rates did not differ between the two groups (p=0.306). The overall recurrence rate and the locoregional recurrence rate also did not differ between the two groups (p=0.835 and p=0.582, respectively). The recurrence rate of IMLN (both ipsilateral and contralateral) metastasis was very low, accounting for 0.5% in the axilla group and 1.3% in the IMLN group (p=0.416). CONCLUSION: The long-term follow-up results showed that there was no significant difference in both overall outcome and regional recurrence between the two groups. Therefore, the requirement for identification of nodal basins outside the axilla or IMLN sentinel biopsy should be reconsidered.
Accounting ; Axilla ; Biopsy ; Breast ; Breast Neoplasms ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphoscintigraphy ; Neoplasm Metastasis ; Nitriles ; Prognosis ; Pyrethrins ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Survival Rate

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