Invasive micropapillary carcinoma of the breast in a male patient: Report of a case

INTRODUCTIONWe report a rare case of invasive micropapillary carcinoma in the male breast.PRESENTATION OF CASEA 63-year-old man was referred to our hospital for investigation of a left breast tumor, which could be palpated in the upper lateral quadrant of the left nipple-areola complex. The tumor invaded the areola skin. Ultrasonography showed a 14.8 × 15.0 × 12.4 mm low echoic mass, with an irregular lobulated border. Core needle biopsy indicated invasive ductal carcinoma, but the subtype could not be accurately determined. Mastectomy with axillary lymph node dissection was performed. Pathological examination indicated invasive micropapillary carcinoma, no lymph node metastasis, and a nuclear grade of 2. Immunohistochemical examination showed positive staining for estrogen and progesterone receptors, but negative staining for HER2. The Ki67 index was 5%. Tamoxifen was administered, and recurrence has not been noted for 1 year.DISCUSSIONWomen's IMPC generally shows a high HER2 positivity rate. However, HER2 positivity was noted in only 1 male patient with IMPC (14%) according to our literature review. Furthermore, in all cases of the mixed type that were reviewed, IMPC was associated with papillotubular carcinoma. These findings may be specific to IMPC in male patients.CONCLUSIONIMPC is associated with a high rate of lymph node metastasis or recurrence and advanced vessel invasion, aggressive adjuvant chemotherapy following surgical resection should be selected for patients with IMPC.     

Composite adeno-endocrine carcinoma of the gallbladder with long-term survival

INTRODUCTIONPrimary endocrine cell tumors in the gallbladder are uncommon, and the coexistence of an endocrine cell tumor and adenocarcinoma, squamous cell carcinoma, and sarcomatoid components is extremely rare.PRESENTATION OF CASEA rare case of adeno-endocrine cell carcinoma of the gallbladder in an 81-year-old woman is reported. Abdominal ultrasonography (US) revealed a hypo-echoic, solid tumor, 2.0 cm × 1.8 cm in size, at the fundus of the gallbladder. On computed tomography (CT), the tumor was well-enhanced, well-demarcated, and homogeneous. The tumor, which was papillary, protruded into the gallbladder with no direct invasion to the liver. The tumor was diagnosed as gallbladder carcinoma; its depth appeared not to pass the subserosa layer. A cholecystectomy and hepatic bed resection with regional lymph node dissection were performed. Histologically, the tumor consisted of several components, including well to poorly differentiated papillary and tubular adenocarcinoma with squamous and sarcomatoid differentiations, and endocrine cell carcinoma. Histochemical studies of these tumor cells were positive for chromogranin A, synaptophysin, and cluster of differentiation 56 (CD56). The lymph node consisted of metastatic adeno-endocrine carcinoma. The patient survived and has remained disease-free for 4 years without adjuvant chemotherapy.DISCUSSIONAdeno-endocrine cell carcinoma of the gallbladder generally has a poor prognosis.CONCLUSIONThe present case suggests that adeno-endocrine cell carcinoma with various components may be derived from a common precursor cell. This observation would require further investigation.     

Hyperfuctioning insular thyroid carcinoma: A rare case report

IntroductionInsular carcinoma of thyroid (ICT) is a rare pattern of thyroid tumor. Being hyperfunctioning makes the condition rarer. Here we reported a case of ICT associated with hyperthyroidism.Case reportA 65-year-old female presented with neck mass for 4 years. She had symptoms of thyrotoxicosis and received antithyroid treatment. She was referred for surgical management. She had multiple, non tender, mobile masses in the neck. Ultrasound showed midline multiple heterogenous mass lesions with multiple lymph nodes in right side of the neck largest one measuring 2 × 2 cm. The patient was prepared for total thyrodectomy with radical neck dissection. The result of histopathology confirmed unifocal, poorly differentiated ICT. The post operative course was uneventful.ConclusionInsular carcinoma is a rare disease. It may present with long history of signs and symptoms of hyperthyroidism. Total thyroidectomy is the main line of treatment.     

Orthognathic surgery during breast cancer treatment—A case report

IntroductionIn recent years, patients with orthognathic surgery in middle-aged and elderly people have come to be a more frequent occurrence. Breast cancer is the most frequently diagnosed cancer in woman worldwide, and its prevalence rate is steadily increasing.Presentation of caseWe report a case of a 47-year-old Japanese woman in whom left-side breast cancer (Stage 1) was unexpectedly found just before orthognathic surgery in April 2012. Breast-conserving surgery was performed (estrogen receptor+, progesterone receptor+, HER2 −, surgical margin+, sentinel lymph node +) that May. From June to August docetaxel (75 mg/m²) and cyclophosphamide (600 mg/m²) were administrated four times every 21 days and thereafter radiotherapy (total 60 Gy) was completed. The cancer surgeon declared the prognosis good and the patient had a strong desire to undergo orthognathic surgery, so in November we performed a bimaxillary osteotomy, and administration of tamoxifen began 6 weeks after the osteotomy.DiscussionThere are breast cancer cases in which the prognosis is sufficiently good for a planned orthognathic surgery to proceed. Good communication among surgeons and the patient is important.ConclusionWe experienced a case in which breast cancer was found just before the orthognathic surgery; we performed a bimaxillary osteotomy, including follow-up tamoxifen administration, during breast cancer treatment.     

Evaluation of HER2/neu oncoprotein in serum and tissue samples of women with breast cancer: Correlation with clinicopathological parameters

BackgroundHER2/neu (HER2) is a proto-oncogen of the EGF Receptor family. The assessment of serum HER2 level is useful for predicting the patients’ response to chemotherapy or hormonal therapy and selection of proper patients for treatment with Herceptin.We aimed to compare serum HER2 levels with immunohistochemistry in tumoral tissues and investigate correlation between these levels and various prognostic factors.Materials and methodsThis cross-sectional study was conducted on 75 patients with breast carcinoma referred to surgical ward of Mashhad Imam Reza’s hospital from November 2008 to February 2009. Pre-operative serum samples were collected and stored in ?20 °C.Surgical samples were investigated for the type of carcinoma, tumor size, lymph node metastasis, stage as well as grade of the tumor. Tissue HER2 over-expression was evaluated by immunohistochemistry (IHC) staining and HER2 levels were studied by ELISA method. Statistical analysis was performed by SPSS software.ResultsSerum HER2 cut-off level was 18.4 ng/ml; 46.7% of patients were serum HER2-positive and 43% were IHC positive. There was a high statistical correlation between these two parameters (P = 0.018).Statistically, there was no significant correlation between serum HER2 and age, tumor size, stage, grade and metastatic lymph nodes (P > 0.05).ConclusionSerum HER2 level assay can be considered as a complementary method besides tissue methods.     

Mixed adenoneuroendocrine carcinoma of the distal bile duct: A case report

IntroductionMixed adenoneuroendocrine carcinomas (MANECs) of the distal bile duct are extremely rare, and only a few cases have been reported in the English literature.Presentation of caseAn 82-year-old man was referred to our hospital for increasing biliary enzymes. Abdominal computed tomography (CT) showed enlargement of the intrahepatic bile ducts and stenosis of the distal bile duct. Endoscopic retrograde cholangiopancreatography showed stenosis of the distal bile duct and a high-density signal at the same site on diffusion weighted imaging. PET-CT showed increased FDG accumulation (SUVmax: 4.5) at the distal bile duct stenosis. Biopsy specimens obtained by endoscopic ultrasonography-guided fine-needle aspiration revealed adenocarcinoma. The patient was diagnosed with adenocarcinoma of the distal bile duct and underwent subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. The resected distal bile duct tumor was 18 × 14 × 12 mm in diameter. Hematoxylin and eosin staining revealed a composite carcinoma with adenocarcinoma and non-adenocarcinoma elements. The non-adenocarcinoma component stained positive for synaptophysin and chromogranin A. The Ki-67 labeling index was 37%. The non-adenocarcinoma component was therefore diagnosed as a neuroendocrine carcinoma. The two composite carcinoma was diagnosed as MANEC of the distal bile duct. The patient was treated with surgery alone and he remained disease-free for 7 months after the surgery.DiscussionThe treatment of MANECs of the bile duct remains controversial and the prognosis is poor.ConclusionsThere is no standard treatment for MANECs of the bile duct. Larger studies are required to establish standard treatment regimens.     

Factores de riesgo de metástasis ganglionares en el microcarcinoma papilar de tiroides

IntroductionPapillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%-51.5%) and lateral (3%-49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis.MethodsRetrospective study whose study population consists of patients with PTMC (size ≤ 1 cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan-Meier survival analysis with log-rank test were performed.ResultsOut of the 161 selected patients, 9.3% (n = 15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056-26.443; P = .043) and extrathyroidal extension (OR 7.687, 95%CI 1.405-42.050; P = .019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P < .001) and radioactive iodine (24.7% vs. 100%; P < .001). During a mean follow-up of 119.8 ± 65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P = .093). No patients died due to the disease.ConclusionsMultifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis.     

A large benign phyllodes tumour of the breast: A case report and literature review

IntroductionPhyllodes tumours are uncommon fibroepithelial lesions that typically grow up to 4 cm in size but 10 cm tumours known as giant phyllodes tumours have been described. We present a case report of a 20 cm benign phyllodes tumour and a literature review.Presentation of caseA 54 years old lady with an enlarging left breast mass measuring 20 cm of 6 months duration presented to our outpatient breast clinic. She also had an incidental right parotid lump. Core biopsy of the left breast mass returned as a cellular fibroepithelial lesion. A mastectomy and axillary lymph node sampling were done and skin cover was obtained from a split skin graft from the thigh. Final histology returned as a benign phyllodes tumour. Her post-operative recovery was uneventful.DiscussionPhyllodes tumours are suspected in middle age women with rapidly enlarging painless breast masses. Though there are some suggestive features on ultrasound and MRI, the key to diagnosis is still histopathology. However, a pre-operative diagnosis may not always be possible as the interpretation of stromal cellularity and degree of atypia needed to differentiate cellular fibroadenoma from a phyllodes tumour is subjective. When a phyllodes tumour is suspected, adequate margins should be taken for optimal outcome.ConclusionSuccessful management of phyllodes tumour involves obtaining a pre-operative diagnosis via a core biopsy when possible and planning for adequate margins.     

Buccal metastasis in a case of carcinoma breast: A rare case report with review of literature

INTRODUCTIONMetastatic lesions to oral cavity from distant tumours account for 1% of all oral cavity malignancies. Oral cavity is a rare site of metastasis from the breast. We describe case report of breast cancer patient with metastasis to buccal mucosa.PRESENTATION OF CASEWe report a case of pre-menopausal woman with left side infiltrating ductal carcinoma breast – T4aN1M0. She received three cycles of neo-adjuvant chemotherapy followed by modified radical mastectomy (MRM) and three cycles of adjuvant chemotherapy and loco-regional EBRT. She presented with a lump in region of MRM scar and a painful swelling in the right cheek, one year afterwards. Core needle biopsy from scar site revealed infiltrating ductal carcinoma. CECT revealed a heterogeneous lesion (1.1 cm × 1.7 cm) in right masticator space, which on biopsy revealed metastatic deposit consistent with infiltrating ductal carcinoma.DISCUSSIONMetastatic lesions to oral cavity from distant tumours are uncommon. They mainly involve bony structures. Primary metastases to soft tissues are rare and accounts for 0.1% of oral malignancies. In our case, patient presented with scar recurrence and distant metastasis at an unusual site. Had it not been for scar recurrence, patient might not have presented to the OPD with oral swelling. A high degree of clinical suspicion and previous history of breast cancer led to detection of metastatic deposit.CONCLUSIONDiagnosis of a metastatic lesion in buccal mucosa is challenging and requires a high degree of clinical suspicion.     

Lymph node metastasis from colon carcinoma at 11 years after the initial operation managed by lymph node resection and chemoradiation: A case report and a review of the literature

INTRODUCTIONLymph node metastasis from colorectal cancer after a disease-free interval (DFI) of >5 years is extremely rare, and occurs in <0.6% cases.PRESENTATION OF CASEA 60-year-old man underwent low anterior resection for sigmoid colon cancer. The lesion was an adenocarcinoma with no lymph node metastasis of Stage II. At 9 years after the colectomy, he was diagnosed with prostate cancer and was treated with radiation and hormonal therapies; at 11 years, he exhibited suddenly elevated carcinoembryonic antigen levels. Computed tomography (CT) and positron emission tomography-CT revealed a 2.0-cm para-aortic lymph nodes swelling invading the small intestine. These lymph nodes and the affected segment of the small intestine were resected, and histopathology of the resected specimen confirmed a metastatic tumor. The patient was administered radiation therapy after 22 cycles of 5-fluorouracil, oxaliplatin and leucovorin. He however presented with a residual lesion in the para-aortic lymph node, but currently, he has been symptom free for 4 years.DISCUSSIONA review of the literature indicates that the median survival of all previously reported patients is 12 months, and that colon cancer with a long DFI might be a slow growing. One of these patients and our patient both had received radiation and/or hormonal therapy for another cancer, which probably impaired their immune systems, thus resulting in metastatic tumors.CONCLUSIONWe report a case of lymph node metastasis after a DFI of >5 years and review relevant literature to assess the significance and possible reasons for delayed colorectal cancer metastases.     

Papillary carcinoma arising from thyroglossal duct cyst with thyroid and lateral neck metastasis

INTRODUCTIONThyroglossal duct carcinomas (TGDC) are rare, with approximately 274 reported cases since the first report in 1915. The prevalence of carcinomas in surgically removed thyroglossal duct cyst (TGD) is less than 1%. The usual recommended treatment for this condition is the Sistrunk operation, but controversies remain regarding the need for total or partial thyroidectomy.PRESENTATION OF CASEA 28-year-old woman was admitted to our hospital with the symptoms of painless midline neck swelling and growing mass. A preoperative computed tomography (CT) showed a 4 cm sized heterogeneous mass at the infrahyoid anterior neck. Ultrasonography of the neck additionally showed suspicious metastatic lymph node at right level VI, both level VI. The patient underwent a Sistrunk operation. The frozen section revealed papillary carcinoma arising from TGDC and also revealed metastatic papillary carcinoma in the right thyroid, at right level III and level VI. Total thyroidectomy, right modified radical neck dissection and central neck dissection were performed. The thyroid gland and TGD were confirmed papillary carcinoma. The dissected neck lymph nodes revealed metastatic papillary carcinoma.DISCUSSIONThe usual recommended treatment for TGD is the Sistrunk procedure. There is controversy regarding whether total or partial thyroidectomy should be performed.CONCLUSIONPhysicians should be aware of extended operation, including thyroidectomy and/or neck node dissection for TGDC with metastatic lesion of thyroid and neck node.     

Cancer du pénis: A propos de 6 cas avec Revue de la littérature

ObjectiveTo report the state of the penile cancer in the urology department at the University Hospital of Rabat and evaluate long-term results of surgical treatment of this cancer.Patients and methodsBetween 1989 and 2009; six patients were treated for penile cancer. The six cases were reviewed retrospectively and the following data were recorded: mode of presentation, site, staging, TNM stage, treatment, evolution and survival.ResultsThe mean age of patients was 60.5 years (48-81 years). All patients had squamous cell carcinoma of the penis.Three patients had a partial amputation of the penis, and two patients underwent total amputation. The median size of the lesion was 4.4 cm (1.5-8 cm). All tumors had a distal location (glans, corona), 5 were localized and non-invasive (PT1 - PT2) and one had infiltrated the urethra (PT3).Two patients had a nodal involvement (N2 and N1).A single bilateral inguinal lymph node dissection was performed and was positive on one side, with a lymph node ≤ 3 cm, and the absence of capsular extension.Two patients were referred for chemotherapy, one referred on a neo-adjuvant-basis (Bleomycin - Methotrexate, Cisplatin) and the other in a palliative goal.The median follow-up was 33 months (6-72 months). Two patients died, one of which was presented immediately with a metastatic mode and the other due to cardiovascular decompensation. Four patients were alive at last count without local recurrence or lymph node.ConclusionCancer of the penis appears to be rare in Morocco considering the small number managed in our hospital. Oncological and functional prognosis (sexual and urinary) depends on the timeliness of treatment. The surgical resection with lymphadenectomy remains the standard treatment.     

A long-term recurrence-free survival of a patient with the mixed adeno-neuroendocrine bile duct carcinoma: A case report and review of the literature

IntroductionNeuroendocrine tumors arising primarily in the bile duct are rare. And among these tumors, mixed adeno-neuroendocrine carcinoma (MANEC) is quite uncommon. We report a patient with MANEC who achieved long-term recurrence-free survival. And our case report includes analysis previous case reports.Presentation of caseA 66-year-old man underwent investigation for persistent anorexia and fatigue. Laboratory tests showed that the values of hepatobiliary enzymes were increased. On CT, a 10 mm × 8 mm hypervascular tumor was observed in the distal bile duct and the proximal bile duct was markedly dilated. Endoscopic retrograde cholangiography (ERC) also showed a stenosis with a long diameter of 10 mm. Examination of a biopsy specimen obtained from the narrow site of the bile duct at the time of ERC revealed tubular adenocarcinoma. Therefore, pylorus-preserving pancreaticoduodenectomy was performed under a preoperative diagnosis of distal bile duct carcinoma. Postoperative pathologic examination revealed alveolar structures and a mixture of moderately differentiated adenocarcinoma with synaptophysin-positive and chromogranin-A-positive neuroendocrine carcinoma. Therefore, the final diagnosis was MANEC, pT3, pN1, M0, pStage II B (TNM classification of the UICC). Curative resection was achieved and there has been no recurrence after 30 months.DiscussionIn the previous reports, only five patients (14.7%) survived for 24 months or longer. Median survival was longer (14 months) in the curative resection group and shorter (6 months) in the non-curative resection group.ConclusionCurative resection is essential to achieve long-term survival in patients with bile duct MANEC, even if these patients have lymph node metastasis.     

Utilidad de la quimioterapia neoadyuvante en el carcinoma vesical músculo invasivo no metastásico

ObjectiveWe analyzed the profile of patients who were candidates for neoadjuvant chemotherapy (NACT) in stage pT2-4aN0M0, the tolerability and adherence of our cisplatin-based protocol and oncological outcomes.Material and methodsRetrospective observational cohort study including patients diagnosed with muscle-invasive bladder carcinoma treated with NACT. Clinical, histopathological, therapeutic and evolutionary characteristics of the patients were analyzed. The use of NACT was evaluated by the complete response in the surgical specimen (pT0). This and other pathological factors were related to overall survival and progression-free survival.ResultsWe included 90 patients with muscle-invasive bladder carcinoma (clinical stage T2a-T4aN0M0) who received a cisplatin-based NACT regimen between January 2011 and December 2018, prior to radical surgery. Forty percent of patients presented an adverse reaction, with a compliance with the NACT regimen of 92.2%. There were no deaths related to systemic treatment and no adverse reaction to treatment made radical cystectomy impracticable. After performing radical cystectomy, the presence of complete response (pT0) was observed in 20 patients (21%), lower stage in the surgical specimen (<pT2) in 36 patients (40%), positive surgical margins in 7 patients (8%), lymph node involvement (N1) in 16 patients (17.8%). A shorter time to progression was observed in the group of patients who did not achieve a complete pathological response (53 months vs. 83.1 in pT0 patients, P = 0.012), in patients with lymph node involvement compared to pN0 (65.4 vs. 28, 2 months, P = 0.014) and in those with positive surgical margins compared to those with tumor-free margins (63.5 vs. 8.5 months, P = 0.021).ConclusionThe adequate selection of patients with muscle-invasive bladder carcinoma has shown a good tolerance to NACT, with a high compliance rate prior to RC. The improvement in the complete response rate implies a greater survival in this group of patients, with lymph node involvement and positive surgical margins being important prognostic factors.     

Marginal zone lymphoma of the breast—A diminished role for surgery

IntroductionPrimary breast lymphoma by definition is localized to one or both the breasts with or without involvement of regional lymph nodes with no other extra mammary site involvement. Role of surgery in the treatment armamentarium is less well defined.Presentation of caseA 62 year old post-menopausal lady was found to have 1.2 × 1.2 × 0.6 cm mass in the left breast on diagnostic mammography. Core needle biopsy reveals marginal zone lymphoma. Complete staging work-up was performed which was negative for regional spread and metastatic foci. She was diagnosed to have a localized stage IE extra nodal low grade marginal zone lymphoma of the MALT type involving breast. She received radiotherapy to the breast and is in remission at follow up after one year.DiscussionAccurate diagnosis requires adequate tissue biopsy either by a core needle or a surgical biopsy for histopathologic evaluation and immunophenotyping. Immunohistochemically the tumors are positive for pan B-cell markers (CD 19, CD 20, CD22, and CD 79a) and lack T cell markers. For stage IE Marginal zone lymphoma radiotherapy alone and for stage IIE combined chemo-radiation offers the best possible control of the disease. Progression free survival for MZL is better than diffuse large B-cell lymphoma.ConclusionAt present the best evidence support radiotherapy in localized disease and combined chemo-radiation in advanced disease. Role of surgery is minimal and is seen in case of diagnostic dilemma. Rarity of the diagnosis precludes large scale prospective studies making therapeutic decisions difficult and challenging.     

Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer

IntroductionThe use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity.MethodsWe retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded.The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups.ResultsA total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old.The overall major surgical morbidity (Clavien-Dindo 3–5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p = 0.643).There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p = 0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p = 0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed.ConclusionsPerioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.     

Clinicopathologic Characteristics and Prognosis of Glycogen‐Rich Clear Cell Carcinoma of the Breast

Glycogen‐rich clear cell carcinoma (GRCC) of the breast is a rare type of breast carcinoma. Knowledge about the characteristics of this type is fragmentary, and the prognosis is on debate. In this study, we aimed to summarize the clinical, pathologic, and biologic characteristics of GRCC of the breast and analyze the survival. We reviewed the cases of breast cancer in our hospital between January 1999 and December 2009 and identified 28 patients as GRCC of the breast. The routine hematoxylin–eosin staining, periodic acid‐Schiff (PAS) staining, and diastase PAS staining were performed on the tumor tissues. The expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER‐2), Ki67 and P53 were evaluated by immunohistochemistry. Tumors with a HER‐2 score of 2+ were confirmed by fluorescent in situ hybridization test. Each GRCC case, who had complete follow‐up data, was compared with four cases of usual invasive ductal carcinomas as controls in the same database and matched with age, year of diagnosis, tumor size, nodal status, and immunophenotype. The chi‐squared test and the Fisher's exact test were used to compare the characteristics of GRCC cases and controls. The univariate analysis was used to study the prognosis, and Kaplan–Meier method was used to compare the survival of two groups. The clinicopathologic and imaging features were analyzed in the GRCC cases. Tumor sizes ranged from 0.8 to 7.5 cm (mean, 3.2 cm). Thirteen cases (46.4%) had positive lymph nodes. The positivity of ER and PR was 61.5% (16 of 26). HER‐2 was positive for three cases (12%). The positivity of Ki67 and P53 were 87.5% and 45.8%, respectively. Twenty‐four cases were followed up from 19 to 158 months. The prognosis of GRCC of the breast was significantly related with the number of positive lymph nodes (p < 0.001), and patients with more than 10 positive lymph nodes were at high risk of recurrence or metastasis. There was no significant difference in overall survival (p = 0.547), and disease‐free survival (p = 0.900) between GRCC of the breast and the usual invasive ductal carcinomas. GRCC of the breast may not have a worse survival.     

Predicting the status of axillary lymph nodes in breast cancer: A multiparameter approach including axillary ultrasound scanning

In a prospective study, we attempted to predict axillary metastases in 135 breast cancer patients by a preoperative multiparameter evaluation including axillary ultrasound scanning (US). After surgery, factors associated with lymph node metastases by univariate analysis were included in a multivariate model. By multivariate analysis, the stronger independent predictors of lymph node metastases were suspicious axillary US (p < 0.001), tumor location in the outer quadrants (p = 0.001) and high Ki-67 index (>10%) (p = 0.002). A predictive model based on these variables, identified a high-risk group (20.0%) represented by women with suspicious axillary US, tumor in the outer quadrants and high Ki-67 index, with axillary metastases in 100%, whereas all patients with opposite features (8.1%) had uninvolved axillary lymph nodes. This multiparameter evaluation including axillary US may be used to optimize the selection of breast cancer patients candidate to sentinel lymph node biopsy or axillary lymph node dissection. The accuracy of this predictive model still requires prospective validation in a larger sample of women.     

Minimally invasive resection of synchronous triple primary tumors of the esophagus,lung, and thymus: A case report

IntroductionReports of synchronous multiple primary tumors are very rare. We report a case of synchronous esophagus and lung cancer combined with thymoma treated with a minimally invasive approach.Presentation of caseIn a 63-year-old patient, cT2 esophageal squamous cell carcinoma was found. Chest computed tomography revealed a lesion in the right upper lobe combined with an antero-superior mediastinal mass. She was treated with one-stage bilateral video-assisted thoracoscopic + laparoscopic esophagectomy with lymph node dissection and lobectomy with complete lymphadenectomy followed by thymomectomy and demonstrated a favorable response at early follow-up, without severe adverse surgical complications and evidence of local recurrence or distant metastasis. But the long-term follow-up is still needed for the evaluation of therapeutic effects of surgery.DiscussionIn the diagnostic procedure we excluded the probability of esophageal carcinoma metastasizing to the lung. Considering the patient's physical condition permit, we performed a minimally invasive surgery for three tumors. Besides, suitable operative incisions are important for the success of surgery.ConclusionTo our knowledge, this is the first case report in which simultaneous minimally invasive resection of esophagus and lung cancer combined with thymoma.     

Desmoid tumour of the breast as a manifestation of Gardner's syndrome

INTRODUCTIONDesmoid tumours of the breast are rare. Although benign, they can mimic breast cancer on physical examination, mammography and breast ultrasound and can also be locally invasive. Even though they occur sporadically, they can also be seen as a part of Gardner's syndrome. We describe a case of desmoid tumour in a woman with Gardner's syndrome where the lesion was mammographically occult.PRESENTATION OF CASEA 63-year old woman presented with four months history of a painful left breast lump. She had a screening mammogram seven months ago which was normal. She is known to have Gardner's syndrome and had a total colectomy, she has also had multiple abdominal desmoids excised in the past. On examination there was a 4 cm × 5 cm firm, mobile lump in the left breast. Her mammograms in the clinic were also normal. Ultrasound suggested a benign lesion of the breast and a core biopsy showed it to be a benign spindle cell lesion. She underwent wide local excision of the lump, the intraoperative mammograms of the excised specimen also failed to detect the lesion. Histopathology of the excised specimen confirmed the tumour to be a benign desmoid tumour. She has now been offered radiotherapy and nonsteriodal anti-inflammatory drugs (NSAIDs) to reduce her chances of a local recurrence.CONCLUSIONA high index of suspicion and a thorough triple examination protocol is necessary to detect rare lesions like a desmoid tumour which can masquerade as breast carcinoma.