Angiosarcoma in irradiated post-mastectomy chest wall

A 61-year-old woman developed an angiosarcoma in the irradiated chest wall 2 1/2 and 4 years after mastectomy for a carcinoma of breast. The two sets of tumours were morphologically distinct and differed immunohistochemically. The short interval between post-operative irradiation and presentation of the angiosarcoma is unusual. The case is discussed in relation to others of allied type.     

Metastatic metaplastic carcinoma of the breast: diagnosis by bronchial brush cytology

Metaplastic carcinoma of the female breast is an uncommon lesion that may metastasize to body sites. To our knowledge, this is the first reported case of pulmonary metastasis diagnosed on bronchial brush cytology. The patient presented with pulmonary symptomatology 1 yr and 3 mo after a left modified radical mastectomy for breast carcinoma. Bronchoscopic examination revealed an endobronchial lesion partially obstructing the bronchus intermedius. Bronchial brush cytology showed the presence of nonkeratinizing squamous tumor cells admixed with a few scattered clusters of tumor cells with glandular features. Histologic review of the original breast lesion showed a metaplastic carcinoma of the breast with a predominant squamous-cell component. Accurate knowledge of a patient's clinical history is necessary to differentiate a second primary lesion from a metastatic one, particularly when the original lesion is so uncommon.     

Cytodiagnosis of angiosarcoma of breast

A 24-year-old female presented with swelling in the left breast for one-and-a-half years associated with pain for last 4 months. During this period, she was operated twice and once again there was local recurrence, the biopsy was interpreted as benign vascular lesion. The case was diagnosed by preoperative cytology as angiosarcoma of breast, after which, she underwent modified radical mastectomy. Angiosarcoma of breast is uncommon with extremely bad prognosis. Familiarity with the clinical and pathologic features is critical in avoiding underdiagnosis and delayed treatment.     

Cytogenetic study of angiosarcoma of the breast

Angiosarcoma of the breast is quite rare, and the development of cutaneous angiosarcoma after segmental mastectomy and radiation therapy is even less common. A cytogenetic analysis of a mammary angiosarcoma arising in a breast after previous irradiation and segmental mastectomy for infiltrating ductal carcinoma revealed multiple clonal rearrangements involving chromosomes X, 1, 2, 3, 4, 5, 6, 7, 8, 9, 15, 17, 20, and 22. No cytogenetically analyzed angiosarcomas of the breast have been reported before. Genes Chromosom Cancer 10:210–212 (1994). © 1994 Wiley-Liss, Inc.     

Low-grade angiosarcoma of the skin of the breast: a complication of lumpectomy and radiation therapy for breast carcinoma.

A case of low-grade angiosarcoma arising in the skin of a breast previously irradiated for breast carcinoma is reported. Initially, an asymptomatic breast mass was detected. Excisional biopsy and axillary lymph node dissection revealed a 1.5-cm infiltrating ductal carcinoma with 21 negative lymph nodes. The neoplasm was staged as T1, N0, M0. The patient was entered in a research protocol and was treated with high-dose external beam (4,860 rad) and iridium implant (1,860 rad) irradiation. Seven years later the patient developed low-grade angiosarcoma of the breast skin. The lesion recurred following excision and eventually was treated by simple mastectomy. The patient never had evidence of lymphedema. Cutaneous angiosarcomas occurring as a complication of lumpectomy and radiation therapy for breast carcinoma are rare. In some reported cases the patients have had lymphedema, a known factor predisposing to angiosarcoma. Furthermore, almost all cases previously reported have been high grade. This case suggests that radiation therapy for breast carcinoma may also be complicated by low-grade angiosarcoma.     

Post-radiation angiosarcoma and bilateral mastectomy

We report the occurrence of bilateral angiosarcoma after radiation therapy for breast carcinoma in a 64 yr-old woman. The first angiosarcoma developed 17 yr after radiation therapy to the right breast; the second angiosarcoma developed 1.5 yr after radiation therapy to the left breast. Recognizing angiosarcoma in radiated breast tissue is essential to appropriate therapy. The role of irradiation after surgery as adjuvant therapy is to be reviewed.     

Angiosarcoma of the breast following segmental mastectomy complicated by lymphedema

A patient is discussed who had angiosarcoma of her lymphedematous right breast develop four years after segmental mastectomy for infiltrating ductal carcinoma. The lymphedema developed and persisted after an indolent and recurrent postoperative infection. The possibility that the second malignancy is a consequence of the chronic lymphedema, similar to the angiosarcomas of lymphedematous extremities after radical mastectomy, is cautiously entertained. This hypothesis is worthy of consideration as more breast conservation surgery is being done, with or without adjuvant radiation therapy, and accumulating evidence suggests that lymphedema of the breast is a common complication of surgery followed by radiation.     

Angiosarcomas of the breast developing post radiotherapy

Aims : This paper describes two contrasting cases of post-radiotherapy angiosarcomas of the breast. They illustrate the spectrum of malignant vascular tumours that may occur in the breast. These tumours are extremely rare and knowledge of their natural history is limited. The prognosis suggested by the few published cases of poorly or moderately differentiated angiosarcomas suggest a poor prognosis often with a fatal outcome. Methods and results : This was confirmed by our first case a poorly differentiated angiosarcoma, occurring 10 years after radiotherapy for breast carcinoma with death occurring from metastatic angiosarcoma 6 months later. Our second, more recently diagnosed case, was a well-differentiated angiosarcoma, occurring 5 years post radiotherapy for breast cancer. She remains well 12 months after the diagnosis of sarcoma but her long-term outlook is more problematic to predict. Only five previous cases of well-differentiated post-radiotherapy angiosarcoma of the breast have been reported with limited follow-up (average 2 years). Conclusions : Communication with the authors of four of the papers since their publication has provided valuable additional information and indicates a potentially good outlook for this woman in the longer term. A second cellular component was also found in these malignant vascular tumours. These spindle cells distinct from the malignant endothelial cells have not to our knowledge been described previously and their possible nature is discussed.     

ACTH-Producing Breast Cancer: A Patient Report

Ectopic ACTH secretion in the setting of breast cancer is extremely rare but when present affects both the tumor’s behavior and the incidence of complications. The patient, a 58-year-old woman, first presented with a mass in her left breast as well as multiple osseous metastases and a right femur fracture. Laboratory data revealed a hypokalemic alkalosis. Her plasma ACTH level was elevated. She was diagnosed with breast cancer with ectopic ACTH secretion, and underwent a left mastectomy and axillary lymph node dissection. Histological examination demonstrated a poorly differentiated neuroendocrine carcinoma with ectopic ACTH secretion. Although the signs and symptoms of ectopic ACTH secretion from a breast cancer are frequently subtle, the recognition of ectopic ACTH secretion from breast cancer is important for patient management.     

Angiosarcomas of the breast developing post radiotherapy

Aims: This paper describes two contrasting cases of post-radiotherapy angiosarcomas of the breast. They illustrate the spectrum of malignant vascular tumours that may occur in the breast. These tumours are extremely rare and knowledge of their natural history is limited. The prognosis suggested by the few published cases of poorly or moderately differentiated angiosarcomas suggest a poor prognosis often with a fatal outcome. Methods and results: This was confirmed by our first case a poorly differentiated angiosarcoma, occurring 10 years after radiotherapy for breast carcinoma with death occurring from metastatic angiosarcoma 6 months later. Our second, more recently diagnosed case, was a well-differentiated angiosarcoma, occurring 5 years post radiotherapy for breast cancer. She remains well 12 months after the diagnosis of sarcoma but her long-term outlook is more problematic to predict. Only five previous cases of well-differentiated post-radiotherapy angiosarcoma of the breast have been reported with limited follow-up (average 2 years). Conclusions: Communication with the authors of four of the papers since their publication has provided valuable additional information and indicates a potentially good outlook for this woman in the longer term. A second cellular component was also found in these malignant vascular tumours. These spindle cells distinct from the malignant endothelial cells have not to our knowledge been described previously and their possible nature is discussed.     

Angiosarcoma of the breast complicating pregnancy

A 32-year-old pregnant lady presented with a rapidly enlarging right breast mass. A fine needle aspiration was suggestive of a malignant phylloides tumour. However histopathological examination after mastectomy revealed a moderately differentiated angiosarcoma. The histopathological and cytological features of this rare tumour together with the diagnostic pitfalls are discussed.     

Aspiration cytology of extramammary tumours metastatic to the breast

This study was undertaken to highlight the use of fine needle aspiration cytology (FNAC) to distinguish tumours metastatic to the breast from primary breast malignancies. A total of 1866 fine needle aspirates of the breast were performed during a period of 7 years. Three hundred and fourteen cases of breast malignancies were diagnosed and 5 (1.5%) out of these cases were metastatic in origin. The metastatic tumors included, 2 cases of malignant melanoma (chest wall and left arm), 1 case each of haematolymphoid malignancy, adenocarcinoma of the ovary, and squamous cell carcinoma (left leg). FNA diagnosis of metastasis to the breast is essential in order to avoid unnecessary mastectomy and to ensure appropriate chemotherapy and/or irradiation treatment.     

Postmastectomy attitudes in women who wear external breast prostheses compared to those who have undergone breast reconstructions

Sixty-four women who postmastectomy wore an external breast prosthesis and 31 women who had breast reconstruction participated in the present study. It was hypothesized that the breast prosthesis group would exhibit more negative attitudes towards their mastectomy experience compared to the breast reconstruction group. Using the Mastectomy Attitude Scale (MAS) the results indicated that both groups were satisfied with their bodies, had a positive outlook towards their lives, implied that sexuality entailed more than having breasts, and felt that mastectomy treatment was necessary to save their lives. Neither group concealed that they had a mastectomy, however, they were not prone to discuss their mastectomy experiences. The findings from the study indicate that the women postmastectomy already had or developed positive attitudes towards themselves and life in general and the method chosen for breast restoration had no apparent impact on these attitudes. Reasons for the sample's positive attitudes are discussed.This study was part of a larger project funded by the Commonwealth Department of Human Services and Health, Canberra, Australia.     

Intracystic papillary carcinoma of the female breast with secretory activity: The significance of aspiration cytology as diagnostic procedure

We report the case of an intracystic papillary carcinoma of the breast in an elderly woman. Gross and microscopic observations support the contention that intracystic fluid is partly a result of secretory activity by the neoplastic epithelial cells and that, intracystic hemorrhage, which may contribute to it, is a secondary event complicating the primary process. Cytology of the aspirated fluid was negative for malignant cells. It is concluded that in the case of large cystic breast lesions, aspiration cytology may not be helpful in establishing the malignant nature of the lesion and that a negative cytology should be interpreted with caution, always taking under consideration the clinical picture of the disease. A concomitant adenocarcinoma was also present in the opposite breast, the second case reported in the literature. © 1995 Wiley-Liss, Inc.     

Mammary Carcinosarcoma Presenting as Rhabdomyosarcoma: An Ultrastructural and Immunocytochemical Study

A mass in the left breast of a 32-year-old woman was first diagnosed as sarcoma with rhabdomyosarcomatous differentiation. Subsequent studies demonstrated a malignant epithelial component to be present, changing the diagnosis to carcinosarcoma. This course of events supports the concept that many, if not all, sarcomas of the breast would be mixed tumors with a malignant epithelial component, if search for the epithelial component was extensive. Carcinosarcomas with rhabdomyosarcomatous differentiation in the breast are rare, but like sarcomas elsewhere, they do not metastasize to regional lymph nodes, but disseminate hematogenously, primarily to the lungs.     

Mammary Carcinosarcoma Presenting as Rhabdomyosarcoma: An Ultrastructural and Immunocytochemical Study

A mass in the left breast of a 32-year-old woman was first diagnosed as sarcoma with rhabdomyosarcomatous differentiation. Subsequent studies demonstrated a malignant epithelial component to be present, changing the diagnosis to carcinosarcoma. This course of events supports the concept that many, if not all, sarcomas of the breast would be mixed tumors with a malignant epithelial component, if search for the epithelial component was extensive. Carcinosarcomas with rhabdomyosarcomatous differentiation in the breast are rare, but like sarcomas elsewhere, they do not metastasize to regional lymph nodes, but disseminate hematogenously, primarily to the lungs.     

Carcinoma in a solitary intraductal papilloma of the breast

Herein is reported a rare case of carcinoma arising from papilloma of the breast. A 63-year-old postmenopausal woman noticed a nodule approximately 1 cm in diameter in her left breast. Ultrasonography indicated a mass with a solid pattern within an intracystic tumor measuring 1.5 × 1.5 × 1.4 cm in diameter located near the left nipple. On total image analysis malignancy could not be denied, therefore lumpectomy with resection of the surrounding tissue was performed. Histologically the tumor consisted of cancerous and papilloma components. The cancer cells had high-grade nuclear atypia, were irregular, and contained abundant eosinophilic cytoplasm with a thin vascular stalk. In contrast, the tumor cells had no atypia, and had a thick stroma in the papilloma components. Both lesions could be distinguished clearly from each other. In addition, a transition from papillary to cancerous elements in some areas was seen. An additional partial mastectomy was performed after the lumpectomy but no carcinoma foci were noted in the excised tissue. Possible occurrence of cancerous change in solitary intraductal papilloma of the breast was suspected.     

Synchronous primary breast cancer and hepatocellular carcinoma in a male patient: a case report

Male breast cancer is a rare malignant disease characterized by hormonal imbalance. Hepatocellular carcinoma (HCC) is the most common neoplasm of the liver, and is generally correlated with hepatitis B or C virus-related cirrhosis. While to our knowledge a case with these two malignant diseases in a same male patient in the concomitant period is an exceptional event, rarely reported in literature. In this report, we present a case in which a Chinese patient with hepatitis B developed a tumor mass that originated from segment V of the liver and presented with right breast nodules at the same time. Synchronous mastectomy and hepatectomy were performed, and standard endocrine therapy and chemotherapy as adjuvant treatment were therefore followed. The diverse histogenesis of the two kinds of cancers highlights the need for us to investigate any common physiopathogenetic elements.     

Primary angiosarcoma of the male breast

We report an exceptional case of primary breast angiosarcoma in a 58-year-old man. This is a very rare breast tumor (0.04% of breast tumors) which may be difficult to diagnose. Treatment is now standardized: radical mastectomy associated with adjuvant chemotherapy for grade III or poorly differentiated tumors. Prognosis is variable, depending on tumor size and histological grade. Diagnosis should be established as early as possible because the 10-year overall survival rate is 80% for low grade tumors and only 20% for high grade tumors.     

Study of axillary lymph node asymmetry in a female population

We analysed a large series of axillary lymph nodes, with and without metastases following radical mastectomy for breast cancer. We found left/right asymmetry in numbers of lymph nodes, and also asymmetry of lymph node dimensions, which could have been the caused by tumoral antigenic stimulation. The distribution of hyperplastic node patterns differed significantly.