Two cases with long-term disease-free survival after resection and radiotherapy for solitary brain metastasis from breast cancer with extensive nodal metastases

Two rare cases, each with a solitary brain metastasis from breast cancer with extensive nodal metastases as the first site of distant metastasis, were locally treated with surgery and irradiation. The outcome of the two treated cases indicated an excellent and non-recurrent post-therapeutic survival period of more than 3 and 8 years, respectively. In a 50-year-old woman (Case 1), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with doxorubicin and tegafur-uracil (UFT) and hormonal therapy with tamoxifen for left breast cancer. The brain metastasis was treated twice surgically followed by radiotherapy. One year and 6 months later, local recurrence of the brain metastasis appeared and was treated surgically again. No other treatment was done thereafter. Since then, no other distant or lymph node metastasis occurred, and to date her outcome has been non-eventful for 8 years and 5 months. In a 63-year-old woman (Case 2), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with cyclophosphamide, epirubicin and fluorouracil (CEF) for right breast cancer. The brain metastasis was treated locally with surgery and irradiation of 50 Gy. She thereafter received no further treatments. Since then neither distant metastases nor local recurrence have developed, and to date the post-treatment outcome has been uneventful for 37 months. Our findings suggest that patients who developed a solitary brain metastasis as the first site of distant metastasis from breast cancer have a chance of achieving long-term disease-free survival when treated with aggressive local therapy, even in the presence of extensive lymph node metastases at the primary surgery site for breast cancer.     

乳腺癌改良根治术术后放疗的疗效及预后影响因素分析

目的 探讨乳腺癌改良根治术术后放疗的疗效及预后影响因素.方法 收集200例乳腺癌改良根治术及术后放疗患者的临床资料,随访3年,统计患者的生存情况、复发情况和远处转移情况,影响乳腺癌改良根治术后放疗患者预后因素采用单因素和Cox风险比例回归模型分析.结果 随访3年,200例患者局部复发或远处转移58例,无病生存142例,...     

The significance of the internal mammary lymph nodes in medially located breast cancer

The efficacy of adjuvant radiotherapy for medial breast cancers in Stage I or II disease was studied with a retrospective clinical analysis. All cases of breast cancer free of axillary node metastases at the time of standard or modified radical mastectomy were included. These were grouped by location and size of the primary tumor. There were 76 medial lesions, including those in the 6:00 or 12:00 axis. Seventeen of these had received postoperative radiation. Lateral tumors included 59. The size was based on the largest linear dimension and grouped less than or equal to 2 cm or greater than 2 cm. At the time of initial recurrence, all areas of metastases were determined. The data suggests that: (1) medial breast cancers have a greater rate of recurrence than lateral ones; (2) adjuvant radiation for medial lesions decreases that recurrence rate to the range of lateral tumors; (3) large lesions may have a greater chance for local recurrence as well as medial lesions of all sizes; and (4) the potential problems with local recurrence may be diminished with adequate radiotherapy as an adjunctive measure. When recurrence does occur, prior radiotherapy seems to delay the appearance of that recurrence.     

44例隐匿性乳腺癌临床分析

目的 分析隐匿性乳腺癌的诊断、治疗及预后情况,总结其诊断和治疗经验.方法 回顾性分析44例隐匿性乳腺癌患者的临床资料,44例隐匿性乳腺癌患者中,16例行乳腺癌根治术,19例行乳腺癌改良根治术,1例行保留乳腺的腋下淋巴结清扫,8例仅行腋下肿物切除.结果 在接受乳腺癌根治术的35例患者中,有4例(11.4%)在术后病理切片中发现原发灶,原发灶的最大直径为0.6～2.5 cm,其中3例为浸润性导管癌,1例为黏液腺癌;另有3例可在标本中见不典型增生.全组有38例患者获得随访,随访时间为12～132个月.32例行手术治疗且获得随访的患者中,2例死亡,3例术后局部复发并带瘤生存;未接受进一步手术治疗患者中,有2例分别于确诊后16和41个月后因浸润性导管癌行乳腺根治术;其余患者均无病生存.结论 对以腋下淋巴结肿大为惟一临床表现、经肿物活检确认为转移性腺癌的女性患者,应高度怀疑隐匿性乳腺癌的可能性.隐匿性乳腺癌的治疗方式可采用腋窝淋巴结清扫后全乳放疗或乳腺癌根治术.

Abstract：

Objective To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Methods Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. Results The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Conclusions Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.     

Breast sarcoma. A clinicopathologic review of 25 cases

Sarcoma of the breast represents less than 1% of primary mammary malignancies; this study reports 25 such cases. The largest group had malignant fibrous histiocytoma (44%), followed by liposarcoma (24%) and fibrosarcoma (16%). Also represented were clear cell sarcoma, neurogenic sarcoma, leiomyosarcoma, and alveolar soft part sarcoma (4% each). Of 19 patients treated by wide local excision or simple mastectomy with or without adjuvant radiotherapy, 11 had local recurrence develop, of which one patient died and nine of the remaining ten had metastases develop. Of the remaining eight patients in this group with no local recurrence, only two had metastases develop. Of the six patients treated by radical or Patey mastectomy, none had local recurrence develop, but two died of metastases. No patient had metastases develop more than 5 years after diagnosis. Regional lymph node involvement with tumor was observed in only one patient (with malignant fibrous histiocytoma) despite regional lymphadenopathy in seven. The overall mortality at 5 years is 64% but does not increase thereafter. The authors' findings suggest that failure to establish local control is associated with a poor prognosis and that wide local excision or simple mastectomy does not provide sufficient clearance to be used as first-line treatment. Excision of the axillary lymphatics and adjuvant radiotherapy are unlikely to be beneficial.     

The significance of local recurrence of carcinoma of the breast

One hundred twenty-one patients with local or regional recurrence of carcinoma of the breast without evidence of distant metastases were treated with megavoltage radiation therapy. All patients had radical or modified radical mastectomy as their initial treatment. The 10 year survival probability of this group of patients is 26 %, with a local control probability of 46 %. Within this group of patients with recurrent disease, factors found to be associated with a poorer prognosis include peripheral nodal recurrence, advanced initial disease stage and short disease free interval. Contrary to expectation, patients with recurrence within the mastectomy scar (as opposed to chest wall recurrence wide of the scar) or a history of previous radiotherapy had poorer local control rates (although not statistically significant), without effect upon overall survival. Comprehensive radiation therapy (peripheral lymphatic plus chest wall) enhanced the local control rate for the entire group and the survival probability for patients with isolated chest wall recurrence compared with limited radiation therapy fields. (Five year survival probability: chest wall irradiation only = 27%; chest wall and peripheral lymphatic = 54%). Patients given systemic therapy at the time of local recurrence showed no survival benefit. Aggressive, comprehensive radiation therapy is indicated for locally recurrent breast cancer. More effective systemic therapy is needed, especially for higher risk patients.     

Oncological results of immediate breast reconstruction: long term follow-up of a large series at a single institution

Background Reconstruction of the breast after mastectomy is an integral part of the complete management of breast cancer. However, a delay in the reconstruction is usually proposed after the mastectomy in case of invasive cancer, while there is a general agreement for immediate breast reconstruction in case of in situ tumors. Patients and methods Among a total of 677 patients having undergone a mastectomy between 1997 and 2001, 518 (76.5%) underwent an immediate breast reconstruction (IBR). All the patients had a Patey mastectomy for invasive cancer (T1–T3). An adjuvant medical treatment was given according to the biological characteristics of the tumor and lymph node status. No patient received any kind of radiotherapy. The median follow up was 70 months (range 13–114). Results The local recurrence rate was 5.2% for the group of IBR and 9.4% for the mastectomy group without IBR (NoIBR). The regional metastases rate was 1.4 vs. 1.3%. The rate of distant metastases was 13.9 vs. 16.4%. Contra-lateral breast tumor was observed in 1.5 vs. 1.3%. Death rate was 10.4 vs. 16.4%. No statistical difference was observed between the two groups in terme of overall survival (OS) and disease free survival (DFS) (HR_{IBR vs. NoIBR}: 1.03 and 0.99 for OS and DFS, respectively). Conclusion At our institution we have compared a large series that have undergone IBR (518) with a control group (159) and followed over a prolonged period of time (70 months). This study provides the best available results to suggest that IBR is a safe and reliable treatment option for the managing invasive breast cancer.     

External beam radiotherapy in the treatment of male breast carcinoma: patterns of failure in a single institute experience

AIMS AND BACKGROUND: We analyzed our own results in the treatment of male breast cancer patients with respect to local control, overall survival and possible prognostic factors for local and distant control. METHODS: Thirty-one patients with 32 carcinomas of the male breast were treated with radiotherapy. Twenty-five patients received radiotherapy to the chest wall including or not regional lymphatics after initial mastectomy (n = 23) or after surgery for local recurrence (n = 2). Median total dose was 60 Gy to the chest wall and 46 Gy to regional lymphatics. Seven patients with metastatic disease were referred for palliative radiotherapy. RESULTS: Overall survival after postoperative radiotherapy was 40% after a median follow-up of 4.3 years. Actuarial 3-, 5- and 10-year survival was 82.6%, 56.5% and 43.5%, respectively. Five-year progression-free survival was 62.5%. Survival was significantly affected by the presence of lymph node metastases (P <0.001). Local recurrence was seen in one patient after 29 months. CONCLUSIONS: Postoperative radiotherapy is important in the management of male breast cancer to improve local control and progression-free survival, resulting in one local failure in our analysis. The presence of lymph node metastases significantly impairs survival.     

Survival and Pattern of Failure Following Locoregional Recurrence of Breast Cancer

This study analyzed prognostic factors at primary diagnosis and at first recurrence for impact on survival after isolated locoregional failure. The aims were: (1) assessment of prognostic factors for time to second locoregional failure, distant failure, and survival in isolated locoregional recurrence of breast cancer after mastectomy; and (2) investigation of the impact of a second locoregional failure on dissemination and survival.Between 1983 and 1985, 99 patients who had undergone mastectomy and then developed isolated local and/or regional recurrences, were treated with radical excision and radiotherapy; none of these patients had distant metastases. Survival and the times to second local failure and distant metastasis were analyzed according to potential prognostic factors.The median follow-up was 123 months; 38 patients were still alive. Median survival was 89 months and the 10-year survival rate was 38%, with no difference between local and regional recurrences. A total of 43 patients developed a second locoregional recurrence after a median of 73 months; primary tumour size and initial node status were significant independent prognostic factors. The annual hazard rates for recurrence were similar for patients developing local failure or systemic recurrence. The 10-year rate of dissemination was 49% for patients with locoregional control, compared with 51% for patients who had a second locoregional recurrence. The prognostic factors for survival were node status at mastectomy and haemoglobin level at first recurrence.The development of a second locoregional recurrence was not associated with an increased risk of dissemination or reduced survival. Differences in prognostic factors for locoregional control and distant metastases suggest that these recurrences represent different biological entities that require different treatment strategies. However, as the achievement of locoregional control had no influence on prognosis, the use of systemic adjuvant therapy may be warranted in a subset of these patients.     

Radiotherapy following mastectomy: indication and contraindication of chest wall irradiation

Purpose: To determine in which cases radiotherapy of the chest wall following mastectomy is indicated, based on the local recurrent rate in patients with locally advanced breast cancer.

Methods and Materials: From 1984 until 1994, 105 patients who had four or more histopathologically confirmed axillary nodes metastases, or T3-4Nany, were subjected to mastectomy and were administered radiotherapy postoperatively using the hockey-stick field, which included the ipsilateral supraclavicular fossa and internal mammary nodes, except the chest wall. Median age was 51 years old (range, 23 to 82 years old). Eighty-five patients underwent radical mastectomy, 18 modified radical mastectomy, and 2 extended radical mastectomy. Fraction size was 2 Gy/day, the weekly fraction size was 10 Gy and the total dose ranged from 44 Gy to 54 Gy (median 50 Gy). Seventy-four patients were administered adjuvant chemotherapy, and 61 patients were administered hormone therapy.

Results: The 5-year disease-free survival rates of the whole study population were 66%. The 5-year chest wall recurrence rates were 10%. The 5-year chest wall recurrence rates of the patients who had no vascular invasion (n = 19) and the patients who had definite vascular invasion (n = 38) were 0% and 24%, respectively (p = 0.036). All the patients who presented chest wall recurrence had four or more axillary nodes metastases. Nine of the 10 patients who presented chest wall recurrence had definite vascular invasion, while there was no information about vascular invasion for the remaining patient. Factors such as age, pathological subtypes, tumor location, estrogen receptors, extent of resection, chemotherapy, and hormone therapy did not influence the development of chest wall recurrence.

Conclusion: Among patients with breast cancer who have four or more positive axillary nodes or T3-4Nany, those who have no vascular invasion or less than 4 axillary nodes metastases do not need to be subjected to chest wall irradiation after radical mastectomy.     

Primary medical therapy for operable breast cancer

Fifty-seven patients with large but potentially operable primary breast cancer were treated with primary medical therapy rather than initial mastectomy, using chemotherapy (15) or endocrine therapy (42) with the tumour remaining in situ. Of patients treated with chemotherapy, one (7%) achieved a complete remission, and eight (53%) a partial response (overall response rate 60%). Only one patient had progressive disease while on chemotherapy. Of patients who received endocrine therapy, one (2%) achieved a complete response, and 19 (45%) a partial response (overall response rate 47%). Two patients progressed on endocrine therapy. Only 10 patients have so far had a subsequent mastectomy (18%), and 17 (30%) have had radiotherapy and/or conservative surgery. The rest are still on medical therapy.With a median follow-up of 19 months (range 6–42 months) only two patients have had a local recurrence after being disease-free and none have developed uncontrollable local recurrence. Eight (14%) have developed distant metastases and four (7%) have died of metastatic disease.Primary medical therapy may offer an effective alternative to mastectomy for patients with operable breast carcinomas too large for conservative surgery and merits further study.     

乳腺癌保乳手术的疗效及生活质量的评估

目的探讨乳腺癌保乳手术的疗效及其生存质量。方法选取180例早期乳腺癌患者,其中56例患者行保乳手术,63例患者行标准根治手术,61例患者行改良根治术。结果保乳手术组具有住院时间较少、手术时间较短、术中出血少等优势,与根治术组(标准根治术组+改良根治术组)相比,差异有统计学意义(P<0.05)。3组患者的生存率、远处转移率、术后复发率差异无统计学意义(P>0.05),保乳手术组患者的心理因子、躯体因子、精神因子和社会支持因子4个方面均显著高于标准根治术组和改良根治术组患者(P<0.05);保乳手术组、标准根治术组及改良根治术组患者术后乳房外观及美容效果差异有统计学意义(P<0.05)。结果早期乳腺癌患者保乳手术的近期疗效较满意,严格掌握相关手术指征、规范切除和术后放化疗等综合治疗措施是保乳手术成功的关键。     

Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer

Purposes: The study evaluates prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. Patients and methods: The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983–85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen.If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. Results: Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5–11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. Conclusions: Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.     

Radiotherapy for outpatients

Radiotherapy can be done on an outpatient basis depending on the patient's cancer stage, radiation method, concurrent therapy, treatment purpose and general condition. Daily treatment time takes only about 1 minute, but the patient has to come 5 times a week for about 6 weeks for radical treatment and about 3 weeks for palliative treatment. If treated with radiotherapy alone, most patients suffer no severe adverse effects in their daily life. Therefore, radiotherapy can be done on an outpatient basis only if the patient is able to come frequently to the clinic for several weeks. Breast cancer patients commonly undergo radiotherapy in the outpatient clinic, such as breast conserving therapy, postoperative therapy and radiotherapy for local recurrence after mastectomy. Prostate cancer is also commonly treated with radical radiotherapy, postoperative therapy and radiotherapy for local recurrence after prostatectomy. Usually, postoperative irradiation for other cancers and radiotherapy for bone metastases are also undergone on an outpatient basis. During outpatient treatment, it is important to predict and avoid severe normal tissue reactions to radiotherapy, such as myelosuppression and/or pneumonitis, before they are apparent by watching the patient carefully.     

Valeur pronostique des sous-types moléculaires et du Ki67 pour les cancers du sein indemnes d’envahissement ganglionnaire après mastectomie : expérience de l’institut Curie–hôpital René-Huguenin et revue de la littérature

PurposeTo evaluate the prognostic value of Ki67 expression, breast cancer molecular subtypes and the impact of postmastectomy radiotherapy in breast cancer patients with pathologic negative lymph nodes (pN0) after modified radical mastectomy.Patients and methodsSix hundred and ninety-nine breast cancer patients with pN0 status after modified radical mastectomy, treated between 2001 and 2008, were identified from a prospective database in a single institution. Tumours were classified by intrinsic molecular subtype as luminal A or B, HER2+, and triple-negative using estrogen, progesterone, and HER2 receptors. Multivariate Cox analysis was used to determine the risk of locoregional recurrence associated with intrinsic subtypes and Ki67 expression, adjusting for known prognostic factors.ResultsAt a median follow-up of 56 months, 17 patients developed locoregional recurrence. Five-year locoregional recurrence-free survival and overall survival in the entire population were 97%, and 94.7%, respectively, with no difference between the postmastectomy radiotherapy (n = 191) and no-postmastectomy radiotherapy (n = 508) subgroups. No constructed subtype was associated with an increased risk of locoregional recurrence. A Ki67 above 20% was the only independent prognostic factor associated with increased locoregional recurrence (hazard ratio, 4.18; 95% CI, 1.11 to 15.77; P < 0.0215). However, postmastectomy radiotherapy was not associated with better locoregional control in patients with proliferative tumours.ConclusionKi67 expression but not molecular subtypes are predictors of locoregional recurrence in breast cancer patients with negative lymph nodes after modified radical mastectomy. The benefit of adjuvant radiotherapy in patients with proliferative tumours should be further investigated in prospective studies.     

早期乳腺癌患者行乳腺癌根治术和保乳术后放疗的生存比较

目的 探讨乳腺癌根治术和保乳术后放疗对早期乳腺癌患者生存情况的影响.方法 选择早期乳腺癌379例,分为根治术组(341例)和保乳术后放疗组(38例).分别观察两组患者的Karnofsky评分和复发情况.结果 随访5年时保乳术后放疗组患者Karnofsky评分显著高于根治术组(P＜0.05);保乳术后放疗组患者1、3、5...     

隐匿性乳腺癌的诊断和治疗

目的 探讨隐匿性乳腺癌的诊断、治疗及预后.方法 收集23例隐匿性乳腺癌患者的临床和随访资料,并进行分析.结果 23例患者均为女性,平均57.7岁.术前行影像学检查22例,其中行乳腺超声检查17例,8例发现可疑结节;行乳腺钼靶摄片9例,阳性3例;行乳腺MRI检查2例,1例发现异常钙化.20例行同侧乳腺癌改良根治术,16例进行化疗,4例放疗.随访期间,2例患者发生肺转移,其中1例多处转移.结论 术前排除其他部位原发癌的可能后,表现为腋窝淋巴结转移癌的患者即可诊断隐匿性乳腺癌.对隐匿性乳腺癌,乳腺必须进行治疗,可行乳腺癌改良根治术或腋窝淋巴结清扫+全乳放疗.     

Local relapse after radiotherapy in locally advanced breast cancer patients

The study includes 99 patients with a locally advanced breast cancer. The mean age was 60.9±12.3 years, and 38.4% of the patients had a T₃ tumors and the remaining patients T₄ lesions. The most common histology was infiltrating ductal carcinoma, and in the 98% of the histologic samples the grade was moderate or high. All patients were treated with modified radical mastectomy, and radiotherapy. 37.4% of the patients received neoadjuvant chemotherapy. The radiotherapy schedule was 50.2%±1.6 Gy (1.8–2 Gy/day) with 1.25 MeV photons. Median follow-up is 4 years. The 5-year local-regional control probability, disease free survival and the distant disease free survival are 96.5%±3.9%, 61.4%±12.3% and 62.1%±12.3% respectively. The 4-year overall survival for patients with T₃ tumors was better than for T₄ lesions (85.8%±11.5% vs 68.5±13.1%) (p=0.18). In conclusion, the management of locally advanced breast cancer, should include surgery, radiotherapy and chemotherapy. The local control was excellent, and although patients die because distant disease they improve ed showed an survival.     

保乳术个体化组织切除范围指征的探讨

目的：建立可以在乳癌保乳术中预测术后局部复发可能的Logistic模型.方法：回顾性研究乳癌根治性手术病例515例,以肿瘤存在广泛浸润的相关因素作为自变量,应用统计软件SPSS11.5中Logistic回归法,分别对乳腺癌瘤体周边2cm以外的乳房内部组织和瘤床所在的皮肤、皮下组织两部位,建立预测存在肿瘤广泛浸润的Logistic模型.再以已知的病例资料为测试样本,验证模型的有效性.结果：建立的Logistic模型,预测乳房内部组织肿瘤广泛浸润的特异度为80.43%,灵敏度为73.46%,符合率为78.61%;预测皮肤、皮下组织肿瘤广泛浸润的特异度为84.34%,灵敏度为80.95%,符合率为83.96%.结论：建立的Logistic模型在保乳术病例中预测术后皮肤、皮下组织复发结果理想,有临床应用价值.     

Analysis of 6 cases of stromal sarcoma of the breast

OBJECTIVE To investigate the clinical and pathological characteristics, diagnosis and treatment of stromal sarcoma of the breast （SSB）. Methods： The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
METHODS The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.
RESULTS All patients were female and one was menopausal. The median age of the patients was 39 years old （range, 20-55）. All cases had a history of a palpable mass. The tumor rapidly augmented in a short time period in 3 patients. One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast. The median tumor radius was 6.0 cm （range, 3-15 cm）. According to the AJCC breast cancer staging standard （6th edition）, 1 case was of stage ⅡA, 2 cases were of stage ⅡB, 2 cases were of stage ⅢB and one case couldn＇t be staged. Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence. Radical mastectomy was suitable for those with pectoralis major muscle involvement. Two patients received simple mastectom）~ 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy. After surgery, all patients were identified as SSB through pathology, with focal ossification in one case and mucinous degeneration in another one case. Four patients who underwent axillary lymph node dissection did not have lymph node metastases. Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months （8-204 months）, 4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months （1 to 4 months） after surgery. One patient had lung metastases at 7 months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period.
CONCLUSION SSB is difficult to diagnose preoperatively and is characterized by its tendency to .recur locally. To obtain negative margins, wide local excision or mastectomy must be performed. Axillary lymph node dissection is not mandatory. The roles of adjuvant chemotherapy and radiotherapy have still been controversial.