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Newly Arising Contralateral Granular Cell Tumor after Wide Excision of Large Breast Granular Cell Tumor: A Case Report.

Hyuk Mun KIM ; Ok Pyeng SONG ; Jong Min KIM

Journal of Breast Disease.2017;5(1):35-38. doi:10.14449/jbd.2017.5.1.35

Granular cell tumor (GCT) of the breast is a rare neoplasm that is usually benign in nature. The results of physical examination and ultrasonographic findings of GCT of the breast often mimic those of other malignancies. A 46-year-old woman underwent wide excision for removal of a large mass in the left breast (about 10 cm in diameter). The pathologic finding of the excised mass was benign GCT. A year after initial surgery, recurrence of the left breast mass was found along with a newly developed mass in the contralateral right breast, which was excised. In this study, we describe the case of a newly developed GCT in the contralateral breast 1 year after excision of a larger breast GCT.
Breast* ; Female ; Granular Cell Tumor* ; Humans ; Middle Aged ; Physical Examination ; Recurrence

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Synchronously Diagnosed Gastric Metastasis from Invasive Lobular Breast Carcinoma, Mimicking Primary Gastric Carcinoma.

Young Duck SHIN ; Seung Myoung SON ; Young Jin SONG ; Sung Su PARK ; Young Jin CHOI

Journal of Breast Disease.2017;5(1):28-34. doi:10.14449/jbd.2017.5.1.28

Gastric metastasis from invasive lobular breast carcinoma is rare. Mostly gastrointestinal metastasis presents as one among multiple metastases, several years after primary diagnosis of breast carcinoma. Herein, we report a synchronously diagnosed gastric metastasis from invasive lobular carcinoma, mimicking primary gastric linitis plastica with pyloric obstruction. We reviewed clinical and pathological findings of gastric carcinoma metastatic from the breast. In particular, we focused on immunohistochemical studies of selected antibodies, including those for estrogen receptors, gross cystic disease fluid protein-15, and caudal-type homeobox transcription factor 2, for accurate differential diagnosis. Clinical suspicion, repeat endoscopic biopsy, and detailed histological analysis including immunohistochemistry are necessary for diagnosis of gastric carcinoma metastatic from the breast.
Antibodies ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Diagnosis ; Diagnosis, Differential ; Genes, Homeobox ; Immunohistochemistry ; Linitis Plastica ; Neoplasm Metastasis* ; Receptors, Estrogen ; Stomach ; Transcription Factors

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Huge Bilateral Breast Hamartoma Accompanied with Pseudoangiomatous Stromal Hyperplasia.

HyungJoo BAIK ; Jin Woo KIM ; Young Mi PARK ; Soo Jin JUNG ; Anbok LEE ; Hye Kyoung YOON ; Tae Hyun KIM

Journal of Breast Disease.2016;4(1):28-32. doi:10.14449/jbd.2016.4.1.28

A 34-year-old woman presented with sudden breast enlargement that had occurred within 6 months. She also had an accessory breast mass on the left axilla. Clinical impression was phyllodes tumor. Needle biopsy revealed fibroepithelial tumor, a mixture of fibrous stroma and pseudoangiomatous stromal hyperplasia. The final pathologic report was hamartoma associated with focal pseudoangiomatous stromal hyperplasia and macromastia. This is the first reported case of bilateral breast hamartoma with hamartoma in ectopic breast tissue. The masses on the right and left breasts weighed 1,980 g and 1,233 g, respectively, while the mass on the left axilla weighed 36 g.
Adult ; Axilla ; Biopsy, Needle ; Breast* ; Female ; Hamartoma* ; Humans ; Hyperplasia* ; Phyllodes Tumor

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Iatrogenic Arteriovenous Fistula after Ultrasonography-Guided Core Needle Biopsy for Breast Lesion.

Heeseung PARK ; Seong Hwan BAE ; Jin You KIM ; Taewoo KANG

Journal of Breast Disease.2018;6(1):29-33. doi:10.14449/jbd.2018.6.1.29

Ultrasonography-guided core needle biopsy has been standard of care for diagnosing suspicious breast lesion. The procedure is safe and has a low rate of complications. Most common complication might be bleeding or hematoma, which could be avoided by careful process or changing it to excisional biopsy or managed by proper management. Rarely, Post-procedural arteriovenous fistula is reported in almost all body fields, which is life quality threatening, not life-threatening. Most of them occur with obvious vessel injury, and their primary end-point of management is the obliteration of fistula by thrombosis. However, we experienced a case of iatrogenic arteriovenous fistula after core needle biopsy for breast lesion with small vessel injury which was not but small ones, and its thrill did not disappear even after thrombosis. We would like to share our clinical learnings from surgical management process of this rare complication.
Arteriovenous Fistula* ; Biopsy ; Biopsy, Large-Core Needle* ; Breast* ; Fistula ; Hematoma ; Hemorrhage ; Iatrogenic Disease ; Quality of Life ; Standard of Care ; Thrombosis

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A Case of Scalp Metastasis from Breast Cancer without Other Distant Metastases.

Hyunjoo YOO ; Sang Uk PARK ; Jun Yong LEE ; Jiyoung KIM ; Se Jeong OH

Journal of Breast Disease.2018;6(1):25-28. doi:10.14449/jbd.2018.6.1.25

Cutaneous metastases of malignant tumors are relatively rare, and breast cancer is the most common malignancy in women with cutaneous metastases. Since newly developed cutaneous lesions can be the first signs of metastases in breast cancer patients, it is crucial to rule out the possibility of malignancy. Although only a few cases have been reported, breast cancer contributes to a large portion of scalp metastases. This case report demonstrates a rare case of breast cancer metastasis only confined to the scalp. The patient was a 55-year-old woman who was diagnosed with scalp metastasis from breast cancer 10 years after the first curative surgery. The scalp lesion was palpable for 4 years and showed a sudden increase in size over a few months. The patient underwent wide excision with flap coverage. After surgery the patient received radiotherapy, but she has refused additional hormonal therapy. To date, there is no evidence of disease recurrence.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Radiotherapy ; Recurrence ; Scalp Dermatoses ; Scalp*

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Clinical Significance of Non-Mass-Like Enhancement of Preoperative Magnetic Resonance Imaging in Breast Cancer Considering Breast-Conserving Surgery.

Min Ji PARK ; Min Young PARK ; Jin Ok KWON ; Kyoung Sik PARK ; Yeong Beom YU ; Jung Hyun YANG ; Soo Min JUNG

Journal of Breast Disease.2018;6(1):20-24. doi:10.14449/jbd.2018.6.1.20

PURPOSE: The purpose of this study was to investigate the significance of non-mass enhancement (NME) findings on preoperative breast magnetic resonance imaging (MRI) when invasive breast cancer patients with single lesions underwent breast-conserving surgery (BCS). METHODS: We reviewed the preoperative MRI findings of 252 patients who underwent BCS from January 2014 to September 2016. Based on the MRI findings, we divided the patients into two groups, those who did and did not have NME, and we retrospectively analyzed the clinical outcomes of the two groups. RESULTS: The NME group had 57 patients, and the no-NME group had 195 patients. The incidence of in situ lesions was higher in the NME group than in the no-NME group (p<0.001). Additionally, the positive resection margin rate on frozen biopsy was higher in the NME group than in the no-NME group (p=0.002). CONCLUSION: When preoperative MRI had NME findings, in situ lesions were more likely to accompany invasive breast cancer lesions, and the positive resection margin rate for frozen biopsy during BCS was high. Therefore, in these cases, the lesion should be excised more widely when BCS is performed, or frozen biopsy for resection margin during BCS should be performed if possible.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Mastectomy, Segmental* ; Retrospective Studies

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Predictors of Positive or Close Surgical Margins in Breast-Conserving Surgery for Patients with Breast Cancer.

Sang Min HONG ; Eun Young KIM ; Kwan Ho LEE ; Yong Lai PARK ; Chan Heun PARK

Journal of Breast Disease.2018;6(1):11-19. doi:10.14449/jbd.2018.6.1.11

PURPOSE: This study aimed to determine the clinical and pathological factors associated with a higher rate of positive or close margins after breast-conserving surgery (BCS) by comparing these patients to patients with a negative margin. The second aim was to evaluate intraoperative resection margin status and reoperation rates for margin control in patients who underwent BCS. METHODS: We reviewed the clinical and pathological data of all women diagnosed with invasive breast carcinoma (IBC) and ductal carcinoma in situ (DCIS) at our institution between January 2006 and December 2016. RESULTS: During the 10-year study period, 785 patients were diagnosed with either IBC or DCIS, and 402 of these patients had undergone a total mastectomy as the primary treatment. The remaining 383 patients who underwent BCS were included in the final analysis. Of these, 100 patients (26.1%) had intraoperative positive or close margins. The remaining 283 patients (73.9%) had a negative margin intraoperatively, but 32 of these patients had positive or close margins on permanent sections. In the multivariate analyses, microcalcifications on mammograms (vs. none; odds ratio [OR], 1.911; 95% confidence interval [CI], 1.156−3.160), in situ carcinomas larger than 2.0 cm (vs. ≤2.0 cm; OR, 3.106; 95% CI, 1.193−8.086), and lumpectomy (vs. quadrantectomy; OR, 2.863; 95% CI, 1.268−6.622) showed a significant association with a positive or close surgical margins. Patients with intraoperative positive or close margins underwent more reoperation than those with negative margins (5.0% vs. 2.8%). CONCLUSION: After BCS, microcalcifications on mammograms, large-sized in situ carcinomas, and lumpectomy were more likely to have positive or close margins.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Multivariate Analysis ; Odds Ratio ; Reoperation

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Necessity of In Situ Hybridization Test of Human Epidermal Growth Factor Receptor 2 (HER2) Status in Breast Cancer Patients with Equivocal HER2 Immunohistochemistry Results.

Hyun June PAIK ; Hee Jun CHOI ; Jai Min RYU ; Sungmin PARK ; Isaac KIM ; Se Kyung LEE ; Jonghan YU ; Seok Won KIM ; Seok Jin NAM ; Jeong Eon LEE

Journal of Breast Disease.2018;6(1):1-10. doi:10.14449/jbd.2018.6.1.1

PURPOSE: Accurate human epidermal growth factor receptor 2 (HER2) status is important in predicting prognosis and providing treatment for HER2-positive breast cancer patients. However, performing in situ hybridization (ISH) can be an economic burden on developing countries. This study aimed to find an alternative to the ISH test by predicting the HER2 status in patients with equivocal immunohistochemistry (IHC) results. METHODS: We retrospectively reviewed the clinical data of 15,535 patients who underwent curative surgery for invasive breast cancer between February 2005 and April 2015 at the Samsung Medical Center. Equivocal HER2 IHC results were obtained for 461 patients. Logistic regression analysis using stepwise selection was performed to identify the clinicopathological factors related to silver in situ hybridization (SISH) status. We analyzed the data by dividing the estrogen receptor and progesterone receptor (PR) into three groups according to Allred score. RESULTS: Multivariable analysis identified poorly differentiated histological grade, lower PR score, higher expression of Ki-67 and p53, and lower expression of cytokeratin 5/6 and epidermal growth factor receptor as predictors of SISH-positive results. The area under the curve for the receiver-operating characteristic curve was 0.74. CONCLUSION: We identified factors related to a positive HER2 status by SISH. However, there was insufficient power in the prediction model for diagnosis and evaluation. Therefore, the SISH test is essential in determining the HER2 status of breast cancer patients when the IHC result is equivocal.
Breast Neoplasms* ; Breast* ; Developing Countries ; Diagnosis ; Epidermal Growth Factor* ; Estrogens ; Humans* ; Immunohistochemistry* ; In Situ Hybridization* ; Keratins ; Logistic Models ; Prognosis ; Receptor, Epidermal Growth Factor* ; Receptors, Progesterone ; Retrospective Studies ; Silver

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Prognostic Value of Estrogen and Progesterone Receptor Expression in Low Proliferative Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer.

Yujin LEE ; Inseok PARK ; Hyunjin CHO ; Keunho YANG ; Jungbin KIM ; Kyeongmee PARK ; Geumhee GWAK

Journal of Breast Disease.2017;5(2):64-70. doi:10.14449/jbd.2017.5.2.64

PURPOSE: Approximately two-thirds of breast cancer are estrogen-dependent cancers, which express estrogen receptor (ER)/progesterone receptor (PR). We investigated the prognostic value of ER/PR expression in human epidermal growth factor receptor 2 (HER2)-negative and low proliferative (Ki-67 ≤20%) breast cancer. METHODS: A retrospective review was performed of 252 breast cancer data records, identified as ER/PR-positive, low Ki-67 proliferation index (≤20%) and HER2-negative. The data were divided into two subgroups: a strong luminal subgroup and a weak luminal subgroup, according to hormonal receptor expression status. Outcome measures included age at diagnosis, tumor size, tumor-node-metastasis (TNM) stage, ER, PR, Bcl-2, recurrent or metastatic characteristics, disease-free survival and overall survival, of each subgroup. RESULTS: There were no statistical differences in TNM stage or tumor numbers between the two subgroups. The strong luminal subgroup was associated with a higher Bcl-2 expression (p<0.001). The weak luminal subgroup was associated with more frequent neural invasion (p=0.051) and lung (p=0.031), liver (p=0.031) and brain (p=0.033) metastases, than the strong luminal subgroup. Disease-free survival was significantly longer in the strong luminal subgroup than weak luminal subgroup (p=0.015). Overall survival was also significantly improved in the strong luminal subgroup relative to the weak luminal subgroup (p=0.014). CONCLUSION: The weak luminal subgroup showed worse prognosis than the strong luminal subgroup, among ER/PR-positive HER2-negative low proliferative breast cancer patients. Weak ER or PR expression, can be considered a poor prognostic factor in ER/PR-positive HER2-negative low proliferative breast cancer.
Brain ; Breast Neoplasms ; Diagnosis ; Disease-Free Survival ; Epidermal Growth Factor* ; Estrogens* ; Humans* ; Liver ; Lung ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Phenobarbital ; Progesterone* ; Prognosis ; Receptor, Epidermal Growth Factor* ; Receptors, Estrogen ; Receptors, Progesterone* ; Retrospective Studies

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Phosphorylated S6 Kinase-1 as Predictive Marker of Lapatinib Efficacy in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer Patients.

Eun Byeol KO ; Min Ki SEONG ; Hyang Suk CHOI ; Chan Sub PARK ; Ji Hye CHOI ; Jin Kyung LEE ; Hyesil SEOL ; Hyun Ah KIM ; Woo Chul NOH

Journal of Breast Disease.2017;5(2):57-63. doi:10.14449/jbd.2017.5.2.57

PURPOSE: The 40S ribosomal protein S6 kinase-1 (S6K1) is a crucial downstream effector of the PI3K/AKT/mTOR pathway. S6K1 overexpression is found in 10% to 30% of breast cancers and is associated with aggressive disease and poor prognosis. Herein, we investigated the relationship between the expression of phosphorylated S6K1 (p-S6K1) and efficacy of lapatinib in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. METHODS: We retrospectively analyzed the data of 36 patients with HER2-positive metastatic breast cancer treated with lapatinib between January 2010 and September 2014. The p-S6K1 expression status of the primary tumor was assessed via immunohistochemistry using a mouse monoclonal antibody. RESULTS: Fourteen of the 36 patients (38.9%) had p-S6K1-positive tumors. The median progression-free survival (PFS) of patients with p-S6K1-positive tumors was significantly longer than that of patients with p-S6K1-negative tumors (13.4 months vs. 7.1 months, p=0.025). In multivariate analysis, p-S6K1 positivity remained an independent, favorable predictive factor for PFS (hazard ratio, 0.32; 95% confidence interval, 0.11–0.97; p=0.044). CONCLUSION: The high expression of p-S6K1 was significantly associated with prolonged PFS, suggesting that p-S6K1 can be a potential biomarker for predicting the efficacy of lapatinib in patients with HER2-positive metastatic breast cancer.
Animals ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Epidermal Growth Factor* ; Humans* ; Immunohistochemistry ; Mice ; Multivariate Analysis ; Prognosis ; Receptor, Epidermal Growth Factor* ; Retrospective Studies ; Ribosomal Protein S6 ; Ribosomal Protein S6 Kinases

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