Biopsy results of new calcifications in the postirradiated breast

A breast biopsy was performed in 19 patients for the finding of new mammographic calcifications without an associated palpable or mammographic mass after breast-conserving surgery and definitive irradiation for early stage breast cancer. The interval postradiotherapy was 9 to 96 months with a median of 34 months. Eleven of the biopsy specimens (58%) were positive for recurrent breast cancer and eight (42%) were negative. The pathologic results from the positive biopsy specimens showed four with invasive ductal carcinoma, two with microinvasive ductal carcinoma, four with intraductal carcinoma, and one with lobular carcinoma in situ (LCIS). Treatment consisted of mastectomy in eight patients, mastectomy plus chemotherapy in one patient, and biopsy for the patient with LCIS. One patient refused a recommended mastectomy. All 11 patients with recurrent carcinoma are alive with no evidence of disease after salvage therapy, although follow-up is short (median, 14 months; range, 0-48 months). Calcifications which developed in a quadrant different from the initial tumor tended to be malignant with four of five having a positive biopsy result. Microcalcifications were not commonly associated with the initial tumor with only five of 19 having microcalcifications. These results show that the development of new calcifications in the postirradiated breast is associated with a positive biopsy rate of 58% and that the tumors which are found tend to be early and potentially salvageable. The positive biopsy rate of 58% in the postirradiated breast is in marked contrast to the lower positive biopsy rate for microcalcifications in the nonirradiated breast as reported in the literature.     

Bone marrow examination in small cell carcinoma of the lung. Comparison of trephine biopsy with aspiration

Bone marrow examinations in 146 patients with small cell carcinoma of the lung were reviewed. The results of trephine biopsy and aspiration were compared in 128 patients in whom both techniques were performed. Twenty-seven of the 128 examinations (21.2%) showed positive aspirates and 30 biopsies (23.4%) revealed metastatic disease. The overall agreement between the aspirates and biopsies was 96.1%. Thirty-one patients (24.2%) had metastatic tumor in either aspirate or biopsy: 4 of these (12.9%) had a positive biopsy with negative aspirate, and 1 (3.2%) showed a positive aspirate and negative biopsy. The Jamshidi needle was used, yielding an average of 4.1 cm of core material per biopsy. The authors conclude that bone marrow biopsy using the Jamshidi needle is equivalent to aspiration. Although both procedures are complementary, a satisfactory specimen obtained with the Jamshidi needle alone may yield nearly equal detection to the combined procedures. Some guidelines for obtaining an optimal biopsy specimen are suggested.     

Breast carcinoma with osteoclast-like giant cells: a case report and review of the Japanese literature

A 41-year-old premenopausal woman with a 3.5 cm freely mobile mass in the upper outer quadrant of the right breast was admitted to our hospital. Fine needle aspiration showed malignant epithelial cells and many multinucleated osteoclast-like giant cells (OGCs). Excisional biopsy revealed an invasive ductal carcinoma. A right modified radical mastectomy was subsequently performed. Macroscopically the tumor was well circumscribed with a dark brown cut surface. Microscopically, the tumor was a grade 2 invasive ductal carcinoma with many multinucleated OGCs adjacent the tumor cells and hemorrhage and infiltration of inflammatory cells in the stroma. The intra-mammary metastasis also contained OGCs and stromal reactions. By enzyme immunoassay, the tumor cells were negative for estrogen receptor but positive for progesterone receptor. The tumor cells were negative for both c-erbB-2 and p53. The OGCs showed positive immunostaining with the monoclonal antibody CD68, demonstrating a histiocytic origin. Lymph nodes were free of metastasis. We also review the Japanese literature concerning breast carcinoma with OGCs.     

An evaluation of excisional biopsy for tongue carcinoma

An evaluation of excisional biopsy for tongue carcinoma (T1, T2) as a surgical treatment was performed. Forty-seven patients who received excisional biopsy among 394 patients with tongue carcinoma (T1, T2) treated in National Cancer Center Hospital during 24 years were examined. These patients were divided into following three groups: group a) patients treated with excisional biopsy only, group b) those treated with excisional biopsy and cryosurgery, group c) those treated with excisional biopsy and radiotherapy. We examined local control rate of these groups, degree of differentiation in histopathological examination, and median cancer free surgical margin. From these we obtained following results: 1) There was no significance in local control rate among these three groups (group a 77%, group b 84%, group c 45%) 2) There were no local recurrences in the patients with cancer free margin of 5 mm or more except when the histopathology showed perineural invasion, lymphatic vessel invasion, and/or deep invasion to the muscle. 3) Even if we had cancer positive surgical margin with excisional biopsy, we could obtain high local control rate (75%) with additional cryosurgery. We conclude that excisional biopsy for tongue carcinoma (T1, T2) is a good method for primary therapy.     

A case of non-palpating breast cancer with huge lymph node metastasis

We report a case of non-palpating breast cancer with huge lymph node metastasis. The patient was a 58-year-old woman who had a huge tumor at her right armpit. The tumor was 4 cm in diameter. Aspiration biopsy cytology for the tumor was performed. The diagnosis is Class V. Mammography showed an ill-defined mass at her right breast. Ultrasonography revealed a low echoic mass at the C area of her right breast. A core needle biopsy for the breast tumor led to a diagnosis of an invasive ductal carcinoma positive for estrogen receptor and progesterone receptor, and negative for HER2/neu protein expression. She received 4 cycles of CEF (E: 60 mg/tri-weekly) plus 12 cycles of paclitaxe (l80 mg/weekly). After chemotherapy, she received muscle preserving mastectomy plus axillary lymph nodes dissection. In histopathology, there were no carcinoma cells in resected breast tissue and resected lymph nodes. Therefore, the effect of chemotherapy was diagnosed as a pathological complete response. After operation, she was administered aromatase inhibitor. The patient has been well and remained disease-free during a follow-up period of 6 years.     

A case of usual (basaloid)-type vulvar intraepithelial neoplasia that failed to respond to imiquimod cream: clinical implications

The authors report a case of usual-type (basaloid-type) vulvar intraepithelial neoplasia (VIN) 3 that failed to respond to imiquimod cream. A 51-year-old Japanese woman visited her local gynecologist complaining of vulvar itching. Atypical cells were noted in cytology smears, but nine vulvar biopsy specimens showed benign proliferation of epithelial tissue. The patient was placed under careful observation for 8 months, when the vulvar smears once again showed atypical cells and biopsy specimens revealed VIN3. The patient was then referred to our hospital where she was given a diagnosis of VIN 3, basaloid type of usual type. The biopsy specimens were positive for p16 and the lesions were confirmed to be human papilloma virus (HPV)-related. We recommended simple vulvectomy but the patient requested conservative treatment with imiquimod cream. With her written informed consent, we prescribed imiquimod cream to be self-administered 3 times a week. Colposcopy and pap smear test were performed every 2 weeks. Four weeks after the start of treatment, a fingertip-sized papule was detected at the patient’s vaginal introitus. By 6 weeks, the lesion had enlarged, and biopsy specimens revealed invasive squamous cell carcinoma. At 7 weeks, we performed simple vulvectomy. The surgical specimen showed stage pT1b keratinizing-type squamous cell carcinoma. HPV-16 DNA was detected in the specimen.     

Clinical significance of the bone marrow examination in small cell carcinoma of the lung

To study the clinical relevance of bone-marrow metastasis, bone-marrow biopsy and aspiration from the posterior iliac crest were performed in 11 consecutive patients with small cell carcinoma of the lung. Six of the 11 patients (54.5%) showed tumor cell involvement in the bone marrow. In 4 patients with bone-marrow metastasis, myelocytes and metamyelocytes were present in the peripheral blood. Aspiration was diagnostically more valuable than bone-marrow biopsy. Bone scintigrams, using 99mTc-MDP, correlated with the bone-marrow involvement except in one case, where false-negative results were obtained. The areas of bone-marrow metastasis did not match well with the positive lesions detected by bone scintigraphy.     

A case of endocrine ductal carcinoma of the breast

A case of endocrine ductal carcinoma of the breast is presented. A 65-year-old woman was admitted with complaints of left breast mass and pain. Physical examination, mammography, ultrasonography, and computed tomography showed a mass 5 cm in diameter in the left breast suggestive of breast cancer, and incisional biopsy confirmed ductal carcinoma. Auchincloss's mastectomy was performed. The tumor, 4.0 x 3.8 cm in size, consisted of a relatively uniform proliferation of tumor cells with round nuclei and abundant eosinophilic cytoplasm. Immunohistochemically, tumors cells were positive for chromogranin A, synaptophysin, and neuron-specific enolase. Endocrine ductal carcinoma with invasion was diagnosed. No lymph node metastasis was observed, and estrogen and progesterone receptors were positive.     

The detection of local recurrence after definitive irradiation for early stage carcinoma of the breast. An analysis of the results of breast biopsies performed in previously irradiated breasts

One hundred forty-five breast biopsies were performed in 139 treated breasts to evaluate for potential recurrent carcinoma of the breast in women previously treated with definitive breast irradiation for early stage carcinoma of the breast. One hundred thirty-four patients had undergone one breast biopsy, four patients had undergone two breast biopsies, and one patient had undergone three breast biopsies. The median interval from completion of definitive irradiation to breast biopsy was 28 months (range, 2 to 117 months). Of the 145 breast biopsies, 52% (76 of 145) were positive, and 48% (69 of 145) were negative. The positive biopsy rate was related to the type of biopsy, the location of the biopsy, and the findings on physical examination and mammography. In patients with a negative physical examination but mammographic findings of a mass, microcalcifications, or both, the positive biopsy rate was 66% (25 of 38). For patients with a mass on physical examination but a negative mammogram, the positive biopsy rate was 28% (nine of 32). For patients with a mass on physical examination and a positive mammogram, the positive biopsy rate was 72% (13 of 18). For patients undergoing an incisional or Tru-Cut (Travenol Laboratories, Deerfield, IL) needle biopsy, the positive biopsy rates were 94% (15 of 16) and 75% (three of four), respectively, whereas the positive biopsy rate for an aspiration cytology was 25% (five of 20). Of the 76 positive biopsies, 64% (49 of 76) were from an in field or marginal location. The rate of detection of a subsequent local recurrence after an initial negative biopsy was 5% (three of 66). Of the evaluable patients, the complication rate was 9% (seven of 81). This study has documented the results of breast biopsies after definitive irradiation for early stage carcinoma of the breast.     

A surgically resected case of advanced gastric carcinoma with peritoneal dissemination after treatment with combined chemotherapy of TS-1 and CDDP

A 60-year-old female had undergone laparoscopic oophorectomy for right ovarian tumor. At the time of surgery, peritoneal dissemination and ascites was observed. Histological examination revealed that the resected ovary, peritoneal nodes and floating cells in the ascites were metastatic adenocarcinomas. Later, the primary malignant lesion was found to be a type 4 gastric carcinoma. The carcinoma was judged to be unresectable and treated by combination chemotherapy with TS-1 and CDDP every 6 weeks. After 3 courses of treatments, upper gastrointestinal series and endoscopic examinations were conducted and revealed a marked reduction of the tumor size. No carcinoma cells were detected by endoscopic biopsy. CT-scan showed complete disappearance of metastatic lesions. Staging laparoscopy was performed for evaluation of the effects of chemotherapy, and no adenocarcinoma cells at peritoneal nodes or ascites were found histologically. We performed total-gasterectomy with D1 + alpha lymph node dissection. Histopathologically, resected specimens showed severe fibrosis in most parts of the stomach. Following chemotherapy, the carcinoma was judged to be Grade 2 by histopathological examination.     

Diagnostic Yield of Touch Imprint Cytology of Prostate Core Needle Biopsies

Touch imprint cytology may provide additional information to core needle biopsy interpretation according to previous reports. The aim of this study was to investigate the diagnostic yield of this method in the diagnosis of prostate carcinoma. For this purpose, 452 transrectal prostate needle biopsies were evaluated from 56 patients. All patients were clinically suspicious of having prostate carcinoma. Two touch imprints were prepared from each fresh biopsy cylinder. Results of the standard histology and of the touch imprint evaluation were compared. Histologically negative biopsy cylinders were further evaluated for prostate carcinoma by fine step serial sectioning. The standard histological examination showed adenocarcinoma in 27 patients. Touch imprint cytology revealed atypical cells suspicious of carcinoma in 38 patients. This group included all 27 patients with positive standard histology and further 11 patients with initially negative core biopsy. Following serial sectioning, in three out of these 11 samples, histological evidence of a carcinoma could be proven. Fine step serial sectioning of all 29 core biopsies negative for carcinoma by standard histological examination, 26 patients remained negative. All three core biopsies initially negative by standard histology but positive after serial sectioning had cytology findings suspicious of carcinoma. We conclude, that in problematic cases the additional use of touch imprint cytology and serial sectioning of prostate core needle biopsies significantly improve the diagnostic accuracy.     

Granular cell tumor of the breast diagnosed by core needle biopsy: a case report

Granular cell tumor rarely occurs in the breast. We report a 69-year-old woman with a right breast mass that simulated carcinoma on palpation, mammography, and ultrasonography. Aspiration biopsy cytology showed no malignant atypical cells. Core needle biopsy was performed to obtain an accurate diagnosis. The lesion was histologically confirmed to be a granular cell tumor. Immunostaining was positive for S-100 protein and vimentin, and negative for keratin, carcinoembryonic antigen, estrogen receptor and gross cystic disease fluid protein-15. The tumor was treated by wide local excision. Surgeons should be aware that granular cell tumor can resemble breast cancer in order to avoid performing a needless radical mastectomy.     

Improving diagnostic accuracy of prostate carcinoma by systematic random map-biopsy

Systematic random rectal ultrasound directed map-biopsy of the prostate was performed in 77 RDE (rectal digital examination) positive and 25 RDE negative cases, if applicable. Hypoechoic areas were found in 30% of RDE positive and in 16% of RDE negative cases. The score for carcinoma in the hypoechoic areas was 6.5% in RDE positive and 0% in RDE negative cases, whereas systematic map biopsy detected 62% carcinomas in RDE positive, and 16% carcinomas in RDE negative patients. The probability of positive diagnosis of prostate carcinoma increased in parallel with the number of biopsy samples/case. The importance of systematic map biopsy is emphasized.     

Bone marrow evaluation in small cell carcinoma of the lung

Bone marrow examination is commonly included in the staging of small cell lung carcinoma (SCLC). We reviewed marrow samples of 103 patients. Marrow examination was mainly performed by unilateral or bilateral biopsy of iliac crests, using a Jamshidi needle. Only 6 of 97 evaluable cases (6.2 per cent) were positive for marrow metastases at staging, and in 3 cases (3 per cent) bone marrow was the only metastatic site. No focal metastases were found in additional sections made from the blocks of negative samples. In our experience bone marrow biopsy was of little value in staging SCLC. Bilateral biopsy plus aspirate, with the addition of more sophisticated staining techniques might, however, provide a higher yield of positive marrow involvement.     

转移灶穿刺活检在肺癌诊断中的应用

目的:探讨肺部病灶活检难度大或者肺部活检组织较少等情况下,转移灶穿刺活检的意义。方法:回顾性分析了自2013年10月至2016年12月于南京大学医学院附属鼓楼医院肿瘤中心接受淋巴结、骨、肝脏等转移灶穿刺活检的20例肺癌患者。对转移灶活检的必要性、转移灶活检的手段、准确性、标本质量、病理诊断及相关副作用进行分析。结果:从2013年10月至2016年12月,共20例患者于肿瘤中心行转移灶穿刺,其中行肾上腺转移灶穿刺1例、骨转移灶穿刺3例、肝脏穿刺4例、皮下包块穿刺5例、淋巴结穿刺7例,结合临床及免疫组化均考虑肺来源（其中肺腺癌13例、肺鳞癌2例、肺小细胞癌4例、1例最终只能确定为肺低分化癌）。对非小细胞肺癌患者行分子检测,其中3例患者因穿刺组织较少难以行分子检测,余12例患者分子检测结果显示EGFR敏感突变阳性率75%（9/12）、ALK融合基因阳性率16.7%（2/12）。所有转移灶穿刺患者均未见严重出血、感染或针道种植转移等并发症。结论:对临床高度怀疑肺癌并且伴有远处转移的患者,在肺部病灶活检难度大或活检组织取材不能满足分子检测时,转移灶穿刺活检可作为重要补充手段,达到较好的诊断效能。     

Immunohistochemically detected tumor cells in the sentinel lymph nodes of patients with breast carcinoma: biologic metastasis or procedural artifact?

BACKGROUND: Sentinel lymph node (SLN) biopsy is a new standard of care for patients with breast carcinoma, and allows enhanced pathologic analysis with serial sections and immunohistochemical (IHC) staining for cytokeratins to be performed on a routine basis. However, the significance of SLN micrometastases detected only by IHC is uncertain. Are these tumor cells truly markers of metastatic potential, or simply evidence of passive displacement by preoperative instrumentation of the tumor site? Here we evaluate whether the pattern of SLN metastasis in breast carcinoma is related to the degree of manipulation at biopsy before surgery, independently of other known predictors. METHODS: Among 4016 consecutive eligible patients with breast carcinoma registered in a prospective SLN database at Memorial Sloan Kettering Cancer Center, we noted patient/tumor characteristics, pathologic status of the SLN (negative, positive by hematoxylin and eosin [H&E], or positive only on IHC), and method of previous biopsy (none, fine-needle aspiration biopsy [FNAB], core needle biopsy, or surgical biopsy). RESULTS: Multivariate analysis showed that the likelihood of an H&E-positive SLN was significantly associated with lymphovascular invasion, tumor size, tumor type, and tumor location, but not with the method of biopsy. In contrast, the likelihood of finding an SLN positive only on IHC was unassociated with any of the four variables above, but was significantly associated with the method of biopsy. After no previous biopsy, FNAB, core needle biopsy, or surgical biopsy, IHC-positive SLN were present in 1.2%, 3.0%, 3.8%, and 4.6% of patients, respectively (P = 0.002). CONCLUSIONS: These data suggest that the frequency of IHC-positive SLN in patients with breast carcinoma 1) is unrelated to conventional predictors of lymph node positivity, 2) is increased after instrumentation of the tumor site, and 3) is increased approximately proportionate to the degree of manipulation. A proportion of IHC-positive SLN were present before biopsy and therefore less likely to be artifactual.     

Primary chemo-radiotherapy and selective oesophagectomy for oesophageal cancer: goal of cure with organ preservation.

PURPOSE: The role of definitive chemo-radiotherapy in squamous cell oesophageal carcinoma has been established by the Radiation Therapy Oncology Group (RTOG). We have studied a modification of the RTOG chemo-radiotherapy protocol in patients with any histologic type of oesophageal carcinoma. We planned oesophagectomy for patients with post-treatment positive endoscopic biopsy or <75% regression on CAT scan, or with resectable local recurrence. Study end-points were histologic response, toxicity, oesophagectomy and survival rates after primary chemo-radiotherapy. METHODS: Consecutive patients with any T or N status, M0, disease encompassable in radical radiotherapy ports, no prior surgical excision, and fit for chemo-radiotherapy, were eligible. Treatment plan was three cycles of cisplatin/5-fluorouracil chemotherapy and radical external radiation therapy (50 Gy in 25 fractions) starting with cycle 2. Selective oesophagectomy was performed in patients with post-treatment positive biopsy or <75% regression on CT scan, or with localized recurrence. RESULTS: From 1993-1996, 32 patients were treated. Post-treatment complete histologic response rate was 77% (95% confidence limits 58-90%). Grade 3 or 4 toxicities occurred in 31 and 3 patients, respectively. Minimum follow-up time was 12 months. Median disease-specific survival time was 16.1 months for all patients, and was not significantly different according to histologic type (17 squamous, 12 adenocarcinoma). Oesophagectomy was performed in six of 15 surviving and five of 17 deceased patients. CONCLUSION: It is possible to cure oesophageal cancer with chemo-radiotherapy and selective oesophagectomy, and achieve organ preservation in the majority of long term survivors.     

超声引导下Mammotome旋切系统在诊断临床不可触及乳腺病灶应用研究

目的 探讨超声引导下应用Mammotome旋切系统,在临床不可触及乳腺病灶的诊断应用价值.方法 2004年6月～2004年9月,采用11 G自动活检刀头对123例265处＜15 mm临床不可触及的乳腺病灶进行B超引导下Mammotome微创旋切术,评价其对临床不可触及乳腺病灶的诊断效果.结果265个乳腺病灶大小3 mm～15 mm(平均9.1 mm),均被Mammotome微创旋切切除.结果术后病理诊断阳性31个病灶(包括不典型增生ADH,原位癌DCIS,LCIS,浸润癌).234个病灶为良性病变.术后B超随防3个月～6个月,未发现乳腺残留病灶.结论应用B超引导下Mammotome旋切系统对临床不可触及乳腺病灶可进行完整切除并获得明确病理组织学诊断,若为良性可获得理想美容学效果,若为恶性可使患者获得早期治疗,提高生存期.     

X线立体定位引导真空负压旋切活检在诊断0期乳腺癌的应用价值

目的探讨X线立体定位引导真空负压旋切活检技术在临床触诊和B超检查均为阴性乳腺微小病灶中诊断0期乳腺癌方面的价值。方法本院于2007年10月～2009年5月用数字化俯卧式穿刺活检定位系统引导真空负压旋切活检系统对113例B超检查为阴性临床不可触及的X线下可疑病灶(BIRADS评级为4级)进行微创切取活检。结果手术成功率100%。113例病例中共发现18例乳腺癌,其中乳腺导管内癌12例,导管内癌并微浸润(浸润突破基底膜小于2mm)4例,浸润性导管癌1例,浸润性小叶癌1例。乳腺癌术后病理分期0期12例,Ⅰ期6例。无严重出血等并发症。结论 X线立体定位引导真空负压旋切活检临床触诊和B超检查均为阴性的X线下乳腺微小病灶,对诊断0期乳腺癌有较高的价值。