Breast metastases from extramammary primary tumors are uncommon, accounting for approximately 1.3~6.6% of all malignant mammary tumors. Apart from hematopoietic neoplasms, malignant melanoma is one of the most common neoplasms with which secondary involvement of the mammary parenchyme is known. Although they are so rare, breast metastases from such neoplasms can mimic primary breast carcinoma clinically and on imaging studies. Approximately 20% of the patients affected by malignant melanoma will develop metastases, the commonest sites being liver, lung, and brain; metastases to the breast from malignant melanoma are rare, and in about 40% of the patients affected the breast lesion is the first manifestation of disease. Correct management of metastatic disease to the breast can prevent unnecessary mutilation; in fact, in the majority of patients so far widespread metastases have appeared rapidly despite various systemic treatments, showing that major surgery gives very poor results in terms of controlling the disease. In this paper, we present the case of a 49-year-old woman with a history of a malignant cutaneous melanoma of nasal cavity that had been surgically excised in 2004. She was admitted to our Breast Division 6 months later because a screening mammogram and anultrasound evaluation had revealed the presence of a nodular opacity in the both breast, without any clinical manifestations. For this reason, in September 2004 the patient underwent a simple mastectomy of both breasts.
Brain ; Breast Neoplasms ; Breast* ; Female ; Hematologic Neoplasms ; Humans ; Liver ; Lung ; Mass Screening ; Mastectomy, Simple ; Melanoma* ; Middle Aged ; Nasal Cavity ; Neoplasm Metastasis*

PURPOSE: Hyperthermia treatments (Laser, Macrowave, Microwave, Electromagnetic force, and Ultrasonic heating system etc.) haves been used for the purpose tof destroying the focus part of tumors. Interstitial Laser Photocoagulation (ILP), originally attempted by Bown in 1983, experimentally makes use of Nd:YAG Laser in breast cancer. This study attempted to evaluate the effect of ILP for the fibroadenomas of the breast under the local anesthesia. METHODS: From the physical examination findings, breast ultrasonogram, mammogram and Fine Needle Aspiration Cytology of 74 unmarried women patients, diagnosed as having a fibroadenoma, which is a breast benign tumor, who took ILP treatment and could be followed up based on their medical records 62 were examined and analyzed. After checking the accurate positioning of the optical fiber in the tumor, through an ultrasonogram under the local anesthesia, the ILP treatment was conducted using a Diode Laser (Diomed(r) Ltd.). RESULTS: The average age of the patients was 23 years, and the mean sizes of the tumors were as 1.6 and 1.8 cm on physical examination and 1.8 cm on the ultrasonogram, respectively. There were significant decreases in the clinical and sonographic sizes following the treatment (P<0.05, P<0.01). From a comparison of the tumor sizes before and after the ILP treatment, the tumor reduction rates from the physical examination and ultrasonogram findings were 92 and 80%, respectively, when the size of the tumors was below 1 cm, and the disappearance rates were 92% and 80%, respectively, when the size of the tumors was below 1 cm. CONCLUSION: Interstitial laser photocoagulation is a safe, precise, minimally invasive, and cosmetic procedure for the in situ destruction of breast fibroadenomas.
Anesthesia, Local ; Biopsy, Fine-Needle ; Breast Neoplasms ; Breast* ; Female ; Fever ; Fibroadenoma* ; Heating ; Hot Temperature ; Humans ; Lasers, Semiconductor ; Light Coagulation* ; Magnets ; Medical Records ; Microwaves ; Optical Fibers ; Physical Examination ; Single Person ; Ultrasonics ; Ultrasonography

Purpose: Breast cancer is one of the most frequent malignant tumors in American and European countries, with incidences increasing every year. In Korea it was the second most frequent cancer in 2002, followed by stomach cancer. However, in 2001 the incidence of breast cancer was first, followed by colon cancer, with incidences increasing every year. Conversely, breast cancer in men is not frequent, with an incidence of less than 1%, according to studies from both Korea and abroad. Studies on the treatment methods and prognostic factors of breast cancer in men are limited, with little clinical experience. Although there was difficulty in collecting complete data, due to lack of awareness of male breast cancer, the clinical characteristics could be determined from the experience and treatment outcomes of male breast cancer patients. Methods: The medical records of 13 male patients with breast cancer, who could be followed up, were retrospectively evaluated from 4809 patients with breast cancer, evaluated between 1989 and 2003. Results: The average age of the subjects was 64.3 years, with the breast masses with no pain situated at the center of the breast in most cases. The affected period in most patients was 1 year, with most having stage II breast cancer. Conclusion: Although asymptomatic unilateral subareolar breast mass in old ages is the most frequent symptom, most missed the period for early treatment due to lack of awareness of male breast cancer, therefore, their breast cancer had been for more than a year. Despite the difficulty due to the lack of data, attention needs to paid, and continuous studies required, toward male breast cancer.
Breast Neoplasms ; Breast Neoplasms, Male ; Breast* ; Colonic Neoplasms ; Humans ; Incidence ; Korea ; Male* ; Medical Records ; Multiple Endocrine Neoplasia Type 1 ; Retrospective Studies ; Stomach Neoplasms

The histological distinction between benign and malignant phyllodes tumors (PT) is often difficult and arbitrary. We analyzed clinical, histological features and expressions of Ki-67 and p53 using immunohistochemistry and estimate its significance in assessing the grade of malignancy and in predicting the clinical behavior of these tumors on 20 cases of PT of the breast (11 benign, 3 low-grade malignancy and 6 high-grade malignancy). Statistically significant differences between benign, low-grade malignant, and high-grade malignant PT by size of tumor, cellular atypism, stromal cellularity, margin of tumor, and number of mitotic figures. The mean labeling index (LI) of Ki-67 in high-grade malignant PT (9.6+/-9.6) was three-fold higher than that in benign PT (2.7+/-2.2), but this difference was not statistically significant (P=0.074). None of the benign PT were positive for p53, whereas 2 of 3 low-grade malignant and 3 of 6 high-grade malignant PT were positive for p53. Statistically significant differences in the pattern of p53 expression existed among the benign, low-grade malignant, and high-grade malignant lesions (P=0.018). Ki-67 LI and p53 expression were associated with numbers of mitotic figure, but were not associated with metastasis (P=0.546 and 0.216). Increased p53 immunoreactivity is present in high-grade and low-grade malignant PTs in contrast to benign PTs, and malignant PT had a higher Ki-67 LI than benign PT. Thus, p53 and Ki-67 expression may assist in distinguishing benign from malignant PT in diagnostically difficult cases.
Breast* ; Immunohistochemistry ; Neoplasm Metastasis ; Phyllodes Tumor* ; Prognosis

PURPOSE: The development of publicized screening methods for breast carcinoma detection has led to a marked increase in the discovery of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCIS-MI). Axillary lymph node status has been believed to be not only an indicator of prognosis, but also a direction of adjuvant therapy. But the incidence of axillary metastasis in DCIS or DCIS-MI has diversely found in from 0% to 20%. This study was performed to analyze the incidence of axillary metastasis and the predictive factors associated with axillary lymph node metastasis in DCIS or DCIS-MI. METHODS: Patients with DCIS or DCIS-MI and axillary lymph node dissection from 1987 to 2004 were selected from Korea University Medical Center. We reviewed their medical records for age, palpability and size of the tumor, histolgic subtype, nuclear grade, hormone receptor status, and pathologic slides. RESULTS: Fifty two patients in DCIS and Thirty eight patients in DCIS-MI were included in the study. Axillary lymph node metastases were identified in 2 patients (3.8%) in DCIS and 4 patients (10.5%) in DCIS-MI. Tumor size and nuclear grade in DCIS had a borderline significance in association with microinvasion. We could not be able to find any predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. CONCLUSION: Axillary lymph node metastasis in DCIS or DCIS-MI appeared to be not low and there was no predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. But DCIS patients with large tumor size and poor nuclear grade have the high possibility associated with microinvasion, therefore, in that cases, there is a need to consider the possibility of axillary metastasis.
Academic Medical Centers ; Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Mass Screening ; Medical Records ; Neoplasm Metastasis* ; Prognosis

purpose: In Korea, the incidence of breast cancer is continuously increasing. Since 2001, breast cancer is the most common cancer in females.(1) Methods: We analyzed the clinical data of 323 breast cancer patients who were treated in department of surgery at Pusan National University Hospital between January 2001 and December 2002. Results: A total of 323 patients, 322 patients are female and 1 patient is male. The most common prevalent age was the fifth decades. The most common sign and symptom was a painless palpable mass. The most common tumor location was the left upper outer quadrant. The main preoperative histologic diagnostic methods were core needle biopsy (48.3%) and Fine Needle Aspiration (35.6%). Breast conservation surgeries were performed in 259 cases (80.2%), a modified radical mastectomy in 35 cases (10.9%), a radical mastectomy in 3 cases (0.9%), a simple mastectomy in 3 cases (0.9%) and other procedures in 23 cases (7.1%). According to the TNM staging system, the most common stage was stage IIA (121 cases, 37.4%). The most common pathologic type was invasive ductal carcinoma (273 cases, 84.6%). Axillary lymph node metastasis was present in 109 cases (33.7%). The most common distant metastasis site was the bone (12 cases, 3.7%). The average follow-up period was 22.3 months. 19 cases (5.9%) were recurred between 15 to 28 months after surgery. Their mean disease- free interval was 21.2months. During the follow-up, 4 patients died. Conclusion: In spite of the short follow-up period, this study shows that breast conservation surgery is a recommendable modality in breast cancer, in terms of recurrence rate, disease free survival, patient's satisfaction and cosmetics.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast Neoplasms* ; Breast* ; Busan ; Carcinoma, Ductal ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Male ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Simple ; Neoplasm Metastasis ; Neoplasm Staging ; Recurrence

PURPOSE: Multiple clinical, biological, and pathologic factors correlate with the outcomes in patients with invasive breast cancer. The utility of a peritumoral vascular invasion (PVI) as an additional prognostic indicator has been poorly defined. The aim of this study was to determine if the presence or absence of PVI can be used to help assess the survival and recurrence. METHODS: An invasion of the vascular space (lymphatic and/or blood vessel) by a tumor, as assessed on routine hematoxylin and eosin sections, was investigated in a 146 women with primary operable invasive breast carcinoma. The presence of PVI was compared with the established prognostic factors such as age, tumor size, axillary lymph node involvement, histological grade, hormonal receptor status, and expression of c-erb B2, Ki-67 and p53. Survival analysis was performed using Kaplan-Meier method and log-rank test. RESULTS: PVI was found in 35.6% of cases and was significantly associated with an increasing tumor size (P=0.033) and metastatic axillary lymph nodes (P=0.012). The 5 year disease free survival (DFS) and overall survival (OS) were significantly lower in the patients with PVI than without PVI (P=0.0431 and 0.0445, respectively). In multivariate analysis, the axillary lymph node status (P=0.001), the tumor size (P=0.044) and PVI (P=0.050) were significant independent prognostic factors for the DFS. In the node- negative breast cancer group and in the node-positive breast cancer group, the 5 year DFS and OS were lower in the patients with PVI than in those without, but this did not show significant difference. CONCLUSION: Cox multivariate analysis showed that PVI is a strong prognostic factor for patients with operable invasive breast cancer and an independent prognostic factor for a recurrence. A histological assessment of PVI can provide prognostic information on primary operable invasive breast carcinoma and might be helpful in making a clinical decision.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Eosine Yellowish-(YS) ; Female ; Hematoxylin ; Humans ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Recurrence

PURPOSE: Epstein-Barr Virus (EBV) is well understood as an oncogenic virus in human tumors. Its association with breast cancers has been reported but is still in controversy. So we have examined the expression of EBV in breast cancers and evaluated the relationship between the well-known prognositc factors of breast cancer and EBV expression. METHODS: A retrospective study was conducted with patients who had been re-evaluated to confirm the diagnosis based on immunohistochemical analysis with EBNA-2 expression, between January 1991 and December 2002. The cases were assigned to the positive lesion that displayed 10% or more of immunoreactive cells. RESULTS: The expressions of EBNA-2(Ebstein Barr virus nuclear antigen - 2) were noted in 26 (21.1%) out of 123 cases of breast cancer patients and 4 (20%) out of 20 cases in a control group of benign tumors. The expression of EBV in breast cancers and that of a control group were not different significantly. But, the correlation between the expression of EBNA-2 and ER status was noted statistically significant (P=0.040). CONCLUSION: Judging from the results of our study, EBV infection detected in breast cancer seems to be latent and the association of EBV to breast cancer is less likely related.
Breast Neoplasms* ; Breast* ; Diagnosis ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human* ; Humans ; Oncogenic Viruses ; Retrospective Studies

PURPOSE: Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients. METHODS: Between December 2002 and August 2003, 38 patients with T1and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. A total of 60 sentinel lymph nodes (mean number, 1.58) were biopsied and first examined by hematoxylin-eosin (H&E) staining. All the tumor free sentinel lymph nodes by H&E stained section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Newcastle, UK) during the operation. Finally, the sentinel lymph nodes were submitted for paraffin embedding and serial section after surgery. Both H&E stained and cytokeratin immunostained sections were also performed. RESULTS: This technique has a turnaround time of less than 20 minutes during the operation. Rapid IHC staining revealed 4 positive sentinel lymph nodes that were negative for metastasis by H&E staining. Among these false negative 4 cases, two cases had problems with the frozen section of H&E staining and the other 2 cases had problems due to micrometastasis. This study showed a sensitivity of 88.89%, a specificity of 100%, an accuracy of 98.33%, and a negative predictive value of 98.08%. The false-negative case (1 of 52), which was negative on H&E staining and rapid IHC staining during the operation, was disclosed as positive only after a serial permanent section examination with IHC stain. CONCLUSION: The introperative examination of sentinel lymph nodes is a highly accurate and effective way of predicting the axillary lymph node status of patients with breast cancers. This may be a promising technique in deciding whether to spare axillary lymph node dissection for the patient in the operating room.
Biopsy ; Breast Neoplasms* ; Breast* ; Decision Making ; Frozen Sections ; Humans ; Keratins* ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Operating Rooms ; Paraffin Embedding ; Prospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy

PURPOSE: E-cadherin is a Ca (2+)-dependent cell adhesion molecule that plays an important role in normal growth and development via the mediation of homotypic, homophilic cell-cell interactions. Recent studies suggest that E-cadherin may also be important in neoplastic progression, particularly as a suppressor of invasion. METHODS: To evaluate the expression of E-cadherin, according to the histopathological features and the relation between E-cadherin and prognosis in breast carcinoma, immunohistochemical staining, using mouse HECD-1 was performed for 66 cases of breast carcinoma. RESULTS: The breast carcinomas showed loss or marked reduction of E-cadherin expression in 42 (63.6%) of the 66 cases. In a multivariate analysis, E-cadherin expression had no independent prognostic value, while the axillary lymph node status, tumor diameter, and TNM stage were independent prognostic factors. The results indicate that E-cadherin expression was related to several histological features in breast cancer, but had no independent prognostic value over standard prognostic factors. No significant correlation was found between E-cadherin expression and tumor size, stage, nuclear grade, lymph node status, histologic type, or hormonal status. CONCLUSION: The loss or marked reduction of E-cadherin expression in breast carcinomas was not related to the prog nosis of the patients.
Animals ; Breast Neoplasms* ; Breast* ; Cadherins* ; Cell Adhesion ; Growth and Development ; Humans ; Lymph Nodes ; Mice ; Multivariate Analysis ; Negotiating ; Prognosis