Bilateral breast metastases from ewing sarcoma of the femur

We report a case of bilateral breast metastases from Ewing sarcoma of the femur. A 40-year-old woman presented with Ewing sarcoma of the left thigh, treated by complete surgical exeresis and chemotherapy. Secondary, a large tumor appeared in the left breast. Bone scintigraphy, chest, and abdominal computed tomographic scan were normal. A breast biopsy found a malignant tumor composed of small round cells consistent with the initial diagnosis. After the first cycle of chemotherapy, a tumor was discovered in the controlateral breast. After 5 cycles, residual tumors persisted in the 2 breasts. Tumor exeresis was performed and found bilateral breast metastases of Ewing sarcoma. Because of the early recurrence of the left breast tumor, segmentectomy of the right breast and left mastectomy were performed. The histopathological analysis confirmed Ewing sarcoma metastases in the left breast. Despite local radiotherapy, the clinical course was marked by lumbar bone metastasis, local chest evolution, and progression of the disease. Metastases to the breast by extramammary malignant neoplasms are unusual. Sarcoma is an extremely rare cause of breast metastases and our case is the first report of breast metastases from Ewing sarcoma.     

Undifferentiated Pleomorphic Sarcoma of the Male Breast Causing Diagnostic Challenges

Undifferentiated pleomorphic sarcoma of the breast are uncommon and often present diagnostic challenges. Herein, we report a case of the undifferentiated pleomorphic sarcoma occurring in the male breast. A 76-year-old man presented with a palpable bean-sized mass in his left breast for two months. Core needle biopsy revealed the presence of atypical cells in a fibrous proliferative lesion, which was removed by wide excision. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle cell lesion with uncertain malignant potential. One year later, the patient returned with a recurrent mass atthe previous surgical site. The mass was again surgically removed using wide excision. Based on histological findings with immunomarkers, the final diagnosis was undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcoma of the breast can cause genuine diagnostic difficulty and appropriate immunohistochemistry is mandatory for differential diagnosis.     

Two cases of stromal sarcoma, so-called malignant fibrous histiocytoma of breast treated with reduction surgery

CASE 1: A 64-year-old woman with right breast cancer had a partial mastectomy and radiotherapy four years ago was admitted to our hospital because of right breast mass. The vacuum associated biopsy of tumor resulted in breast sarcoma, thus a nipple-spearing mastectomy was performed. The final histological diagnosis was stromal sarcoma, and was identical to histological findings of malignant fibrous histiocytoma. Three months after the operation, a chest wall recurrence appeared. Although tumor resection with latissimus dorsi flap was performed, there were pleural dissemination and malignant pleural effusion. She died six months after the first surgery. CASE 2: A 60-year-old woman was admitted to our hospital because of left breast mass, but she refused a further clinical examination. She readmitted fourteen months later due to a huge sized left breast mass with necrosis and smelling discharge. CT scan showed a huge tumor of left breast and multiple lung metastases. Biopsy of the tumor resulted in breast sarcoma. Total mastectomy with split thickness skin grafting was performed. The final histological diagnosis was identical to the first case. A local recurrence appeared thirty days after the operation, and she died fifty-one days after the operation.     

Diffuse cystic angiomatosis of the breast

Vascular tumors of the breast are extremely rare, and the majority are malignant. In this report, the presentation of a diffuse, benign, cystic, vascular tumor that histologically was angiomatosis of the breast is described. The clinical presentation, magnetic resonance imaging (MRI) appearance, and histologic features of this rare lesion are reviewed. This case is of particular interest because the tumor recurred during pregnancy and underwent massive enlargement despite negative hormone receptor values. Angiomatosis is prone to local recurrence, so complete excision with histologically negative margins is the treatment of choice.     

Nodular fasciitis of the breast simulating breast cancer on imaging

Nodular fasciitis is a rare benign soft tissue tumour of the breast that clinically and radiologically can mimic invasive duct carcinoma. The clinical, radiological and pathological findings of nodular fasciitis of the breast in a 38‐year‐old woman, who presented with a palpable lesion in the upper inner aspect of the left breast, are described. The tumour is characterized histologically by a stellate spindle cell tumour with a focal myxoid background containing scattered inflammatory cells and microhaemorrhages. Pathological assessment of the lesion is essential in making the diagnosis.     

Nodular fasciitis of the breast

Nodular fasciitis of the breast is a rare, benign, soft-tissue tumor that can clinically and radiologically mimic invasive ductal carcinoma. A 25-year-old woman presented with a palpable lesion in the lower inner aspect of the left breast. Radiologically, breast carcinoma could not be excluded. On examination of the core needle biopsy, the tumor was characterized histologically as a spindle cell tumor. Excisional biopsy was performed. The tumor was diagnosed as nodular fasciitis of the breast. The imaging and histological findings of this case are presented.     

Nodular fasciitis of the breast

Nodular fasciitis of the breast is a rare, benign, soft-tissue tumor that can clinically and radiologically mimic invasive ductal carcinoma. A 25-year-old woman presented with a palpable lesion in the lower inner aspect of the left breast. Radiologically, breast carcinoma could not be excluded. On examination of the core needle biopsy, the tumor was characterized histologically as a spindle cell tumor. Excisional biopsy was performed. The tumor was diagnosed as nodular fasciitis of the breast. The imaging and histological findings of this case are presented.     

Bilateral angiosarcoma of the breast detected by magnetic resonance imaging during pregnancy

Angiosarcoma of the breast is an aggressive malignancy of endothelial origin with a tendency for localregional recurrence. The involvement of angiosarcomas in the bilateral breasts has rarely been documented. Of note, due to its rarity and typically unclear clinical findings upon examination, the diagnosis of a contralateral lesion can be difficult, particularly in women during pregnancy. Here we present a rare case of bilateral angiosarcoma of the breast during pregnancy. A 32-year-old woman was referred to our unit with complaints of progressive swelling of the left breast, with tenderness. Magnetic resonance imaging showed a small, circumscribed high-intensity area in the contralateral breast, with pattern similar to that of the lesion found in the left breast. The contralateral lesion revealed only equivocal findings with the other diagnostic modalities. Diagnosed as angiosarcoma preoperatively, excision of the bilateral tumors was performed. Histological findings of the removed bilateral tumors were compatible with high-grade angiosarcoma of the breast.     

Sudden hemorrhage without skin invasion in a patient with Breast Cancer: A case report and literature review

We report a rare case of sudden hemorrhage caused by breast cancer. A 70-year-old Japanese woman noted fresh bleeding from her left breast. On physical examination, continuous hemorrhage accompanied by an open cavity was observed in the left breast. Mammography and ultrasonography revealed a well-circumscribed mass, with solid and cystic components, that was highly suggestive of intracystic breast carcinoma with direct skin invasion. Computed tomography and bone scintigraphy showed no distant metastasis. Aspiration biopsy of the lesion showed several clusters of adenocarcinoma cells. Modified radical mastectomy was performed with a presumptive diagnosis of stage III B left breast cancer. Invasive ductal carcinoma without skin invasion was diagnosed histologically. To the best of our knowledge, only 6 other cases of sudden hemorrhage caused by breast cancer without skin invasion have been reported in Japan. We review the literature and discuss the clinical characteristics of this unusual phenomenon.     

Bilateral synchronous spindle cell, apocrine and scirrhous carcinoma breast cancer in a case or malignant lymphoma

An unusual case of synchronous bilateral breast cancer occurring during combination chemotherapy and radiation to the outside of the breast for malignant lymphoma is reported. Two histologically rare carcinomas, spindle cell carcinoma and apocrine carcinoma, were observed in this case. A 77-year-old woman, who had been treated for stage IIIA non-Hodgkin's lymphoma, developed bilateral breast tumors. Aspiration biopsy cytology findings of the tumor in the left breast showed several clusters of adenocarcinoma cells and some large atypical spindle shaped cells, which suggested spindle cell carcinoma. The cytologic findings of the right breast tumor were highly suggestive of scirrhous carcinoma. A modified radical mastectomy was performed on both breasts. Pathological examination disclosed two separate cancer lesions in the left breast. The lesion which had been detected before the operation, was a spindle cell carcinoma. Another lesion, detected for the first time by pathological examination, was an apocrine carcinoma. The lesion in the right breast was a scirrhous carcinoma. Since non-invasive foci were detected in these three cancer lesions, each lesion was thought to be a primary cancer. All dissected bilateral axillary lymph nodes showed malignant lymphoma. Immuno-histochemistry of the spindle cell carcinoma revealed positive immunoreactivity for cytokeratin, which suggested the epithelial as well as mesenchymal nature of this tumor. Synchronous existence of malignant lymphoma and three independent breast cancers including spindle cell carcinoma and apocrine carcinoma is very rare.     

Early detection of a deep-seated synovial sarcoma by magnetic resonance imaging

An 18-year-old man who complained of left thigh pain was referred to our institute. No abnormal findings were detected on physical examination and plain roentgenogram or gallium scintigram. On magnetic resonance imaging (MRI), a high-signal of 1-cm diameter was seen in the left vastus medialis muscle on T1- and T2-weighted images. The lesion was initially considered to be: (1) angiolipoma, which is usually associated with fatty tissue, based on the MR findings or (2) a sport-induced inflammation based on the patient's history of baseball playing. Because of the persistent thigh pain and similar findings on the second MRI, an excisional biopsy was performed; the lesion was diagnosed histologically as synovial sarcoma. Additional wide resection was carried out later, without adjuvant therapy. He has been disease-free for 3 years postoperatively. Many soft tissue sarcomas are discovered with extensive tumor formation and are accompanied by obvious abnormal findings on various imaging studies. It is extremely rare that deep-seated sarcomas are discovered without obvious abnormalities. To the best of our knowledge, this is one of the smallest detected deep-seated soft tissue sarcomas. MRI was the most sensitive and useful procedure for detecting the lesion. Physicians should recognize that painful lesions may possibly be synovial sarcoma, even if they are demonstrated as a subtle lesion of 1-cm diameter on MRI.     

Local recurrence after conservative surgery for breast cancer

The advent of limited operative therapy for breast cancer has produced both good cosmetic results and local recurrence. In our department we treated 38 cases with conservation surgery for early stage breast cancers between February 1988 and October 1994, and local recurrence occurred in 2. PATIENT 1. A 56-year-old-woman had a 1 x 0.8 cm tumor in the C region of the left breast. A quadrantectomy with axillary dissection (level 2) was performed as the margin of the nipple side was negative, followed by entire breast irradiation (50 Gy). Approximately four years after the first operation she developed a local recurrence in the CD region of the breast. A salvage mastectomy with subclavicular lymph node dissection was performed. After the second operation she appears to be healthy. PATINENT 2. A 54-year-old-woman noticed a 1 cm tumor located in the EAC region of the left breast. Excisional biopsy showed solid-tubular carcinoma. The distance between the nipple and the tumor was only 0.7 cm. A wide excision with axillary dissection (level 2) was performed as the margin of the nipple side was negative on the frozen section. Neither irradiation of the entire breast nor the adjuvant chemotherapy could be performed. After a three and a half year follow up local recurrence beneath the operative scar was recognized, and an additional wide excision was performed. A half year has passed since the second operation, there have been no signs of recurrence and she appears to be healthy. In conclusion, we experienced two local recurrences in 38 cases of breast conservation surgery for early breast cancers. One patient had multicentric cancers with histologically different types: mucinous and noninvasive ductal carcinoma, and another had a very short distance between the nipple and the tumor and did not undergo chemotherapy or radiotherapy.     

Preoperative intra-arterial infusion chemotherapy in locally advanced primary breast cancer-tissue concentrations of 5-fluorouracil and adriamycin, and the histological evaluation

The effect of preoperative intra-arterial infusion of mitomycin C, 5-fluorouracil (5-FU) and adriamycin (ADM) were studied in seven patients with locally advanced breast cancer, including five inflammatory carcinomas, and a patient with stromal sarcoma of the breast. Reducing rate of the primary tumor of more than 30% was observed in all cases, and remarkable degenerative changes of tumor cells were histologically noted in six out of eight surgical specimens. The tissue concentrations of 5-FU and ADM were also studied in five breast cancer patients. There was no correlation between the concentration of 5-FU or ADM and histological effect. In intra-arterial infusion, ADM seemed to have a high affinity to the regional lymphnode and breast tumor, compared to normal breast tissue and might also be applicable to the control of lymphnode metastasis. Three out of six cases which received radical mastectomy subsequently had recurrence except in the regional lymphnodes and the prognosis was unsatisfactory (5 year survival was 2/4). Other alternative or multi-disciplinary treatment seems to be necessary for improving the survival rate.     

Les sarcomes mammaires primitifs au CHU de Brazzaville

Malignant breast sarcoma is rarely observed. We report here the types of this histological variety. We conducted a retrospective study for 13 years (1996–2008). It concerned the locations of primary breast sarcomas histologically confirmed and monitored in the radiotherapy and oncology department of the CHU of Brazzaville. During the study period, 999 cases of breast cancer were observed, and 4 (0.4%) of them were for breast sarcoma. The mean age was 32.7 years, with extremes of 19 and 45 years. The consultation motive was a big tumor (18.6 cm on average), with collateral circulation and no lymphadenopathy. Four types of sarcomas were found: spindle cell sarcoma, rhabdomyosarcoma, malignant hemangiopericytoma, and histiocytofibrosarcoma. Outcome was bad despite mastectomy and chemotherapy.     

Postirradiation sarcoma (malignant fibrous histiocytoma) of axilla.

A case is reported of a patient who developed a histologically unusual sarcoma in the axilla and chest wall 8 years after receiving radiation therapy (6500 rad) for carcinoma of the breast. This sarcoma showed light- and electron-microscopic features of a malignant fibrous histiocytoma, a tumor not documented among 24 previously reported cases of postirradiation sarcoma following the diagnosis of breast carcinoma. In addition, the literature is reviewed and discussed regarding postirradiation sarcoma in general following breast carcinoma.     

A case of basal cell carcinoma of the nipple and areola with intraductal spread

We report an 82-year-old Japanese woman with basal cell carcinoma of the left nipple and areola extending into the lactiferous duct. The patient developed a small papular lesion of the left areola about 1 year before admission. The lesion, which had slowly progressed to involve the nipple, had become symptomatic showing weeping and bleeding. Mammography revealed microcalcification in the nipple. Although Paget's disease was suspected from these clinical features, histologically basal cell carcinoma was diagnosed. There was no axillary lymphadenopathy, and no evidence of distant metastasis. The lesion of the nipple and areola was resected with a 2 cm free margin along with the underlying mammary tissue. The patient has remained well without signs of recurrence for 2 years after surgery. We reviewed cases of basal cell carcinoma of the nipple or areola and discuss considerations and problems of this rare tumor.     

Alveolar soft part sarcoma metastatic to the breast

Metastasis to the breast is uncommon, with an incidence of 0.5–3%. Alveolar soft part sarcoma is rare, accounting for <1% of malignant soft tissue tumors, which are themselves unusual. Excluding contralateral breast and hematologic malignant disease, the primary lesion in most cases of metastasis to the breast is melanoma, small cell carcinoma of the lung, or ovarian carcinoma, although rhabdomyosarcoma is the most common primary tumor in children. We describe a 26-year-old woman with no history of malignant disease who presented with two masses in the right breast that clinical evaluations and ultrasonography indicated were fibroadenomas. Pathological studies after excisional biopsy, however, indicated alveolar soft part sarcoma. Subsequent computed tomography showed the primary tumor in the anterior left thigh and multiple bilateral lung metastases. Because of the presence of distant metastases, the patient was treated with chemotherapy. © 1996 Wiley-Liss, Inc.     

Breast Cancer and Secondary Cancer Recurrences After Autologous Tissue Reconstruction

BackgroundThe medical literature defining breast cancer recurrence and secondary cancers after autologous tissue reconstruction for breast cancer is sparse. We sought to identify and analyze occurrences at our institution.Patients and MethodsA 20-year retrospective review of cancer recurrences and atypical breast neoplasms after autologous tissue breast reconstruction at Roswell Park Comprehensive Cancer Center was conducted after being granted a waiver from the institutional review board.ResultsEighteen locoregional recurrences among 337 cases were identified and analyzed. Overall recurrence rate was 5.3%. Four secondary cancers (1.2%) were radiation-induced angiosarcoma, undifferentiated pleomorphic sarcoma, and metaplastic carcinoma. One case of flat epithelial atypia was identified.ConclusionOur retrospective review found incidence and survival after treatment of breast cancer concordant with reports in the literature. We also identified and analyzed secondary neoplasms, including a unique case of undifferentiated pleomorphic sarcoma and metachronous recurrence of breast carcinoma. A case of recurrence as metaplastic carcinoma was identified.     

上皮样肉瘤临床诊治分析

背景与目的:上皮样肉瘤是一种少见的软组织肉瘤, 多表现为肢体远端的结节或溃疡性病变,可通过腱鞘局部播散、淋巴道和血道转移.因其切除后易复发转移、有较高的淋巴结转移率而区别于其他的软组织肉瘤.本文通过分析上皮样肉瘤临床特点,治疗效果,生存情况,预后因素,旨在探讨其治疗方法及预后的影响因素等.方法:回顾我院1999-2007年收治的获得随访的18例上皮样肉瘤,对其临床表现、淋巴结转移、治疗情况、生存率及预后进行分析.结果:上皮样肉瘤5年生存率为41%,局部复发率为44.4%.即使截肢,术后仍有复发.在11例行淋巴结清扫的患者中淋巴结转移率为63.6%.结论:上皮样肉瘤是一种侵袭性较强、淋巴结转移率高、术后易复发的软组织肉瘤,手术应充分考虑切除的广泛性.     

Late onset of tonsillar metastasis from breast cancer.

A 71-year-old woman non-smoker referred for repeated haemoptysis showed a tumoral lesion of the left tonsil. Pathological analysis of the biopsy showed characteristics compatible with a breast carcinoma metastasis, in which oestrogen and progesterone receptors were present. The patient had undergone mastectomy and had received adjuvant radiotherapy 24 years previously for a breast cancer with no complaints or signs of recurrence since. Investigations showed disseminated bone metastases but no other soft-tissue deposits. Anti-oestrogen therapy was applied. Only seven similar cases of tonsillar metastasis from breast cancer have been reported.