1/175. Unusual vascular changes in the red pulp of the spleen accompanying breast carcinoma metastasis. The prevalence of splenic metastasis from carcinomas varies between 2% and 13% in autopsy studies. Most of them are clinically inapparent. We report herein the case of a splenic metastasis revealing breast carcinoma in a 73-year old woman. splenectomy was performed to correct hypersplenism. Macroscopically, the cut surface of the spleen was uniform and pale. On microscopical examination, the metastatic infiltration involved both red and white pulp as single cells, cords and micro-nodules. Tumor cells were positive for cytokeratin and epithelial membrane antigen (EMA). The breast origin of this splenic metastasis was supported by the increase of CA 15-3 level, and by the appearance of axillary lymphadenopathy. In addition, the red pulp sinuses were obliterated by multiple thrombi at different stages of development and the splenic cords were collagenized. These changes could result from an unusual stromal reaction. ( info) |
2/175. Observations on the histopathologic diagnosis of microinvasive carcinoma of the breast. Our histopathologic criteria for diagnosing microinvasive carcinoma of the breast may be enunciated as follows: (1) cytologically malignant cells in the stroma associated with in situ carcinoma, (2) absence of basement membrane and myoepithelial cells around the invasive cells, (3) frequent accompanying stromal alterations in the form of myxomatous change and loosening of connective tissue, and (4) the frequent presence of an inflammatory cell infiltrate composed of lymphocytes and plasma cells. Most or all of these four features are present in cases of ductal microinvasive carcinoma of the breast, but the lobular type is not likely to be accompanied by stromal changes or a lymphoplasmacytic cell infiltrate. The minimum information regarding microinvasive carcinoma of the breast that should be conveyed in the final pathology report includes size as measured by the ocular micrometer or a statement that microinvasion refers to a lesion smaller than 1 mm, the number of foci of invasion, and the spatial distribution of the invasive foci. The nuclear grade of the invasive cells and the size, type, and nuclear grade of the accompanying DCIS should be specified. The status of margins, presence of vascular channel involvement (a rarity in microinvasive carcinoma of the breast), and degree of proliferative changes in adjacent nonneoplastic breast tissue should be reported. Immunostains for basement membrane and myoepithelial cells may be helpful in the diagnosis of microinvasive carcinoma of the breast. Sclerosing lesions such as radial scar and sclerosing adenosis can simulate microinvasive carcinoma of the breast, especially when the latter is associated with in situ carcinoma. Caution should be exercised in cases wherein in situ malignant cells may be dislodged by needling procedures or during dissection of the excised specimen. cautery-induced artifacts also hinder optimal histologic assessment. In some cases, it is virtually impossible to determine if true invasion is present, and the statement "microinvasive carcinoma of the breast cannot be entirely excluded" may be employed as a last resort. We consider the latter diagnosis to be the last refuge of the diligent pathologist and do not recommend it unless all diagnostic measures, including examination of deeper levels and supplemental stains, have been exhausted. It may be necessary to seek an expert opinion in "difficult" cases, particularly in the event that therapeutic decisions are to be based on the determination of invasion. From a clinical perspective, the management of microinvasive carcinoma of the breast ought to be dictated by the individual circumstances in each case. Based on currently available data, which admittedly suffer from lack of diagnostic uniformity, the vast majority of patients with microinvasive carcinoma of the breast will be node-negative and can look forward to an excellent prognosis. It is hoped that since the UICC has adopted a previously recommended definition of microinvasive carcinoma of the breast, prospective or retrospective studies with uniform diagnostic criteria will be conducted that will enable more definitive conclusions regarding the treatment and prognosis of microinvasive carcinoma of the breast. ( info) |
3/175. Detection of bilateral multifocal breast cancer using Tc-99m sestamibi imaging. The role of delayed imaging. PURPOSE: Early determination that breast cancer is bilateral and multifocal can change therapy strategy and, subsequently, mortality and morbidity rates. The authors present a case with bilateral, multifocal breast cancer detected only by Tc-99m sestamibi imaging. methods: Early and delayed Tc-99m sestamibi imaging and dynamic MRI were performed in a patient with a right-sided lesion shown on mammography. RESULTS: Although early Tc-99m sestamibi imaging detected bilateral breast cancer foci, both dynamic MRI and mammography missed the lesion in the left breast. Additional lesions seen on delayed Tc-99m sestamibi images of the left breast, which were initially thought to be benign, completely disappeared after concomitant chemotherapy and radiotherapy, suggesting multifocal malignant lesions in the left breast. CONCLUSION: This case suggests that Tc-99m sestamibi may be useful for detecting bilateral cancer, and delayed imaging may give additional information regarding the possible multifocal nature of the disease. ( info) |
4/175. Contrast-enhanced computed tomography detection of occult breast cancers presenting as axillary masses. Some non-palpable breast cancers presenting as axillary metastases (occult breast cancer, OBC) are not clinically detectable by either mammography (MMG) or ultrasonography (US). We performed contrast-enhanced computed tomography (CE-CT) in order to locate the primary tumors in five cases of OBC and succeeded in locating all of them. ( info) |
5/175. Orbital metastasis due to interval lobular carcinoma of the breast: a potential mimic of lymphoma. A 53-year-old woman had an orbital mass composed of a neoplastic small round cell infiltrate and no apparent extraorbital primary tumor. Although the initial diagnosis was primary orbital lymphoma, a combination of mucin histochemistry and immunohistochemical staining for cytokeratin and estrogen receptors led to the discovery of an impalpable lobular carcinoma of the breast. We discuss how detailed histopathological assessment can lead to beneficial therapy. ( info) |
6/175. Lobular carcinoma-in-situ within a fibroadenoma of the breast. We present a case of an in-situ lobular carcinoma within an otherwise benign fibroadenoma in a 45-year-old woman. ( info) |
7/175. Invasive cystic hypersecretory ductal carcinoma of breast: a case report and review of the literature. Few individual cases of invasive cystic hypersecretory ductal carcinoma of the breast have been described. review of 33 cases of cystic hypersecretory carcinoma, including the current case, indicate that only 6 cases presented with invasive disease. Two of these cases had positive nodes and 2 had distal metastases. The case presented here is unique in an additional aspect: the contralateral breast harbored lobular breast carcinoma 10 years after mastectomy of the first malignancy. Bilateral breast disease resulting in bilateral mastectomies over long-term follow-up, as in the case presented here, was reported in 3 of 33 cases. ( info) |
8/175. Microinvasive carcinoma of the breast: can it be diagnosed reliably and is it clinically significant? Deciding whether in-situ breast carcinoma is associated with microinvasion is a common problem. Histological features resembling invasion can be simulated by in-situ carcinoma distorted by inflammatory and reparative changes. Having expended the effort to diagnose genuine microinvasion, just how useful is this diagnosis in planning further treatment and follow-up? In the following articles, Hoda et al. comment on the utility of immunohistochemistry in resolving uncertainty about the presence of microinvasion, and Ellis et al. critically appraise the definition of microinvasion and its clinical significance. ( info) |
9/175. Uterine metastases from breast cancer in a patient under tamoxifen therapy. Case report. The authors report a case of metastases of breast cancer confined to the uterus and cervical subserous leiomyoma in a postmenopausal woman under tamoxifen therapy for two years. After abnormal uterine bleeding, pathologic examination on biopsy of a cervical polyp revealed cervical involvement secondary to lobular breast cancer. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pathologic examination of the surgical specimen revealed both invasion of breast origin and of the cervix until the isthmus, endometrium and cervical subserous leiomyoma. The adnexa uteri were not affected. The possibility of uterine metastases in patients suffering from breast cancer, either undergoing tamoxifen therapy or not, always has to be considered. ( info) |
10/175. Lobular carcinoma of the breast metastatic to the oral cavity mimicking polymorphous low-grade adenocarcinoma of the minor salivary glands. The oral cavity is a rare site of metastatic lesions; however, metastatic breast carcinoma must be included in the differential diagnosis of tumors of that site in women. We describe a 54-year-old woman who presented with a lesion of the floor of the mouth that histologically resembled polymorphous low-grade adenocarcinoma of the minor salivary glands, which was eventually established to represent metastatic lobular breast carcinoma. The final diagnosis was based on comparison with a primary tumor resected 13 years earlier and immunohistochemical reactivity with antibodies to steroid receptors. Relevant aspects of lobular breast carcinoma, polymorphous low-grade adenocarcinoma, and metastatic oral cavity lesions are discussed. ( info) |