Invasive Ductal Carcinoma of the Breast Associated with Poland's Syndrome: Report of a Case

We report herein a rare case of invasive ductal carcinoma of the breast associated with Poland's syndrome. The patient was a 59-year-old woman who was referred to our department after a nodule had been found in the upper outer portion of the left breast by a breast cancer screening program. On physical examination, marked hypoplasia of the right breast and upper limb was noted. Preoperative computed tomography also revealed a defect in the right pectoralis muscles. A quadrantectomy of the left breast with lymphadenectomy was subsequently performed and pathological examination of the resected specimen showed invasive ductal carcinoma. Her medical history revealed that her mother had attempted to abort the pregnancy around the fifth week of her gestation. The present case suggests that such an event during gestational development may be associated with congenital anomalies predisposing to malignant disorders. Received: January 10, 2001 / Accepted: July 17, 2001     

Long extensive transverse myelitis associated with aquaporin-4 antibody and breast cancer: favorable response to cancer treatment

CONTEXT: Long extensive transverse myelitis (LETM) seldom develops in patients with breast cancer who are aquaporin-4 antibody (Aqp-4 Ab)-positive. Whether this association is coincidental is not well understood. FINDINGS: A 62-year-old woman presented with treatment-resistant LETM and Aqp-4 Ab. Two months later, a stage 3 invasive ductal carcinoma was detected in her right breast. Following tumor resection and chemotherapy, her neurologic symptoms and magnetic resonance imaging findings significantly improved and serum Aqp-4 Ab disappeared. The breast tumor samples of this patient and neurologically normal patients showed inflammatory infiltrates and Aqp-4 expressing cells. Conclusion/Clinical Relevance: The temporal association between tumor treatment, amelioration of clinical findings, and seroreversion suggest that coexistence of cancer and LETM is not coincidental. Cancer screening should be considered at least in treatment-resistant LETM cases.     

Breast neurilemmoma: A diagnostic challenge

Breast neurilemmoma or schwannoma is an unusual, benign, slow growing tumour that may develop on any part of the body with the neck, head and extremities consisting the most common sites. Herein, we describe the case of a 65-year-old woman who presented with a tumour-like lesion in her right breast during her screening mammogram which had increased in size during the last three years. Fine needle aspiration biopsy helped not only to reach diagnosis but to rule out malignancy. Excisional biopsy was undertaken and specimen pathology demonstrated a benign schwannoma. The lesion follows a benign course and local recurrence is extremely rare.     

Massive arm necrosis as a result of a subclavian artery occlusion after mastectomy and radiotherapy

A 60-year-old woman with a severe necrosis caused by a blunt trauma of her right upper arm is described. She had a history of ablation and radiotherapy of her right breast followed by a diagnosis of breast cancer 34 years previously. An angiogram revealed a complete occlusion of the right subclavian artery. After the reperfusion of the right arm, the necrosis at the upper arm was resected. After further operations, the wound could finally be closed with a skin graft. Today, the patient is able to complete all her activities of daily living. Despite a restriction in her range of motion, she complains about intermittent pain. Arterial occlusion of the ipsilateral limb is a rare event decades after mastectomy and radiation. A related necrosis in these dimensions and successful limb-saving treatment has not been previously described.     

Long extensive transverse myelitis associated with aquaporin-4 antibody and breast cancer: Favorable response to cancer treatment

Abstract

Context

Long extensive transverse myelitis (LETM) seldom develops in patients with breast cancer who are aquaporin-4 antibody (Aqp-4 Ab)-positive. Whether this association is coincidental is not well understood.

Findings

A 62-year-old woman presented with treatment-resistant LETM and Aqp-4 Ab. Two months later, a stage 3 invasive ductal carcinoma was detected in her right breast. Following tumor resection and chemotherapy, her neurologic symptoms and magnetic resonance imaging findings significantly improved and serum Aqp-4 Ab disappeared. The breast tumor samples of this patient and neurologically normal patients showed inflammatory infiltrates and Aqp-4 expressing cells.

Conclusion/Clinical Relevance

The temporal association between tumor treatment, amelioration of clinical findings, and seroreversion suggest that coexistence of cancer and LETM is not coincidental. Cancer screening should be considered at least in treatment-resistant LETM cases.     

A new clinical presentation: breast implant pneumocapsule and pneumothorax following penetrating chest wall trauma

Pneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstrated a large right sided pneumothorax with associated punctured right breast implant, a ‘pneumocapsule’ and extensive subcutaneous emphysema of the breast. This case highlights that the fibrous tissue capsule around a breast implant can function as an anatomical space in continuity with the thoracic cavity, masking the diagnosis of pneumothorax in penetrating trauma.     

Angiosarcoma of the breast: A case report and literature review

PURPOSE: Primary angiosarcoma of the breast is a rare occurrence. METHODS: We report a case of a 35- year-old woman who presented with a highly vascular mass that had nearly replaced her right breast. RESULTS: Initial diagnosis reported the tumor as benign. However, permanent sections were sent to the Mayo Clinic, where the diagnosis of angiosarcoma of the breast was confirmed. The mass was removed via a total mastectomy. Adjuvant chemotherapy was also prescribed. A review of the literature suggested that the benefits of adjuvant chemotherapy were not well defined, but in the case described, adjuvant chemotherapy appeared to offer the best prognosis. CONCLUSIONS: Preoperative radiography is generally not indicated for angiosarcoma. Primary angiosarcoma of the breast is difficult to diagnose, with no pathognomonic features radiographically. We concluded that solid-appearing breast tumors, which are also highly vascular, should be considered malignant until proven otherwise. Surgical removal followed by adjuvant chemotherapy appears to afford the best prognosis.     

Amyloid tumour of the breast simulating carcinoma

A case is presented of a 55-year old woman with longstanding rheumatoid arthritis who presented with a lump in her right breast and a markedly enlarged right axillary lymph node. Carcinoma of the breast with lymphadenopathy was diagnosed clinically, but excisional biopsy revealed an amyloid tumour of the breast and amyloid lymphadenopathy. Amyloid tumour of the breast is an infrequently reported lesion and the association of axillary lymphadenopathy has not been reported before. The literature is reviewed and the need for a tissue diagnosis prior to embarkation on specific therapy is emphasized.     

Benign schwannoma of the breast: Report of a case

We report herein the case of a 62-year-old woman who presented to our hospital for investigation of occasional pain in her left breast. Although there was no mass palpable in her left breast, mammography and ultrasonography revealed a round tumor in the upper outer quadrant of the right breast. Although the mammography findings indicated that the tumor was benign, the possibility of a malignant neoplasm could not be ruled out by the ultrasonographic images. A final diagnosis of schwannoma was established by histopathological examination of the excised mass.     

Idiopathic benign breast calcification

A 56-year-old woman who came in for screening mammography was found to have extensive unilateral calcification of her left breast which had developed since her previous screening mammogram. The calcification had a ductal and lobular appearance. Possible known etiologies are discussed, but these do not explain the appearance in this case, implying that the cause is idiopathic.     

Adenomyoepithelioma of the Breast: An Intricate Diagnostic Problem

BACKGROUND: Adenomyoepithelioma (AME) of the breast is a biphasic very uncommon tumour with epithelial/ my-oepithelial components. It can be easily recognised in an excised lesion, but it is more difficult to make a definitive diagnosis with needle biopsy. CASE REPORT: We report the case of a 42-year-old woman who presented with a mass in her right breast. The patient underwent a fine needle aspiration, and a diagnosis of C5 carcinoma was made. Neoadjuvant treatment was proposed to the patient but she refused and was referred to a third level centre where a needle core biopsy was performed and a diagnosis suggestive of AME was made. CONCLUSION: If there is cytological atypia, AME may be confused with infiltrating ductal carcinoma in needle biopsies because of limited tissue sampling.     

Synchronous Bilateral Breast Cancer with Paget's Disease and Invasive Ductal Carcinoma: Report of a Case

We report a case of synchronous bilateral breast cancer with Paget's disease and invasive ductal carcinoma. A 60-year-old Japanese woman presented with an 8-month history of discharge from the left nipple with eczema and itching. Mammography showed grouped fine calcification in the right breast, which was highly suggestive of right breast carcinoma with an intraductal component. Ultrasonography did not reveal any mass lesions in the bilateral breasts, and computed tomography and bone scintigraphy showed no site of distant metastasis. We performed a modified radical mastectomy for Paget's disease in the left breast and breast-conserving surgery for ductal carcinoma in the right breast. The histological diagnosis was Paget's disease in the left breast and invasive ductal carcinoma with a predominant intraductal component in the right breast. There was no metastasis in any of the 24 left axillary lymph nodes resected. We also gave her postoperative adjuvant chemoendocrine therapy, comprised of tamoxifen (20mg) and UFT (uracil/tegafur) (400mg) daily. The patient has been disease-free for 4 years since her operation.     

Oncoplastic surgery after mammary reduction and mastopexy for bilateral breast cancer lesions: Report of a case

We report a case of bilateral breast cancer lesions treated successfully by partial oncoplastic surgery. A 46-year-old Japanese woman presented with a small mass in the right breast. Mammography showed neither a mass nor calcification in the right breast; however, an irregular-shaped mass lesion was shown in the left breast. Ultrasonography and fine-needle aspiration biopsy revealed ductal carcinoma in situ in the inner-upper quadrant of the right breast and invasive ductal carcinoma in the outer-upper quadrant of the left breast. We considered that it would be difficult to obtain a good symmetrical outcome after partial mastectomy for the bilateral breast lesions because of the asymmetrical location of each lesion and her ptotic breasts. Thus, we performed bilateral partial resection, followed by an inferior pedicle reduction mammaplasty-type operation, with and without axillary lymphadenectomy, and achieved good cosmetic and oncologic results.     

Cerebrospinal fluid pseudocyst of the breast

A 39 year old lady presented with a lump in her right breast. She was known to have had a ventriculo-peritoneal shunt inserted for childhood hydrocephalus. Mammography revealed a calcified, fractured shunt with an associated soft tissue swelling which resolved following shunt removal. Shunt fracture secondary to calcification is extremely rare, and presentation as a breast lump has not been previously described. This case identifies a rare cause of breast lumps and highlights the importance of complete triple assessment in all patients presenting with a breast lump.     

Schwannoma of the breast showing massive exophytic growth: a case report

Schwannoma is a slow-growing tumor that frequently occurs in the extremities, the trunk and the head region. Its occurrence in the breast is rare with only a few cases being reported. We present here the case of breast schwannoma in a 41-year-old woman who presented with a palpable mass in her right breast. This is the first report of breast schwannoma that showed massive exophytic growth with invasion of the skin, and it was initially presumed to be a breast cancer on preoperative mammography, ultrasonography and breast MRI examinations. Complete excision of the mass was done and pathology revealed a plexiform schwannoma.     

An unusual case of an enlarging mass on a screening mammogram: a case report and review of the radiology and current literature

We report the case of a woman who was recalled after screening because an opacity seen on her previous screening mammogram had changed in appearance. The new features were of a circumscribed soft-tissue opacity with some lobulation. Ultrasound showed an oval mass which was slightly hypoechoic compared to the surrounding fatty parenchyma and contained small focal anechoic areas. The lesion was biopsied and found to be a cavernous haemangioma. Haemangioma of the breast is a rare cause of a well-circumscribed soft-tissue mass on a mammogram.     

Carcinoma of the breast metastatic to the optic nerve mimicking an optic nerve sheath meningioma: case report and review of the literature.

Isolated metastatic tumors to the optic nerve are extremely rare. We describe a rare and unusual case of metastatic breast carcinoma to the optic nerve that mimicked an optic nerve sheath meningioma in its presentation due to its indolent symptom progression, initial radiological appearance, and minimal growth on serial imaging. The patient, a 46-year-old woman with a history of stable metastatic breast carcinoma, presented with progressive visual loss in her right eye over a 6-month interval. Magnetic resonance imaging revealed an enhancing lesion in the optic canal with an extension to the right anterior clinoid process and planum sphenoidale and into the right orbital apex, consistent with the presumptive diagnosis of optic nerve sheath meningioma. The tumor was resected and pathologically confirmed to be metastatic carcinoma of the breast. The clinical course, radiological features, surgical approach, and treatment strategies are reviewed.     

Appropriateness of MRI scanning in the detection of ruptured implants used for breast reconstruction.

This case report highlights the problems associated with ruptured silicone breast implants used for breast reconstructive purposes. The patient originally presented with vague symptoms and signs to her GP and was extensively investigated over a period of years for left-sided chest/abdominal pain. Two separate scanning modalities were used prior to her being seen by either of the main authors and although none were employed specifically to assess for implant rupture, neither detected any free silicone around the hemithorax. The authors suggest that patients who have undergone breast reconstruction with a silicone implant may present in a manner not suggestive of implant damage. In such cases, where the silicone can extend over larger anatomical distances and where side-effects can be damaging the investigation of choice should be MRI scanning which has a greater accuracy for detecting free silicone and defining the extent of spread.     

Adenomyoepithelial Adenosis of the Breast: Clinical, Radiological, and Pathological Findings for Differential Diagnosis

BACKGROUND: Myoepithelial cells are widely present in the breast, and their hyperplasia may result in a spectrum of disease ranging from myoepitheliosis to myoepithelial carcinoma. CASE REPORT: A 46-year-old woman presented with a palpable mass in her right breast. Mammography and ultrasonography showed a lesion in the upper quadrant of the right breast with spiculated borders and shape. Excisional biopsy showed adenomyoepithelial adenosis. CONCLUSIONS: Although considered benign, adenomyoepithelial lesions tend to recur due to inadequate excision. Therefore, possibility of recurrence and even metastasis should be considered during follow-up of patients with a diagnosis of adenomyoepithelial lesions.     

Breast carcinoma in pregnancy: a clinical case

Breast cancer is a rare, but frequently hidden pathology. A woman, 36 years old, during the early months of pregnancy found a little tumor in her right breast. A fine needle biopsy was negative for cancer. Despite this, the tumor rose and two months after delivery (the patient breast-fed her daughter for a month), she had pain in the right axillary region and the tumors involved all superior dials of the right breast. A Madden mastectomy was performed. The histopathological report was: ductal invasive breast cancer 3 of 19 lymph nodes involved, stage IIIA, TNM pT3N2M0, ER -, PgR +--. Chemotherapeutic regimens were: at first ADM 75 mg/m2 for 5 cycles, and after CMF 1-8 for 6 cycles. After six months the woman had a cutaneous recurrence in the scar of mastectomy, treated with surgery and RT. Thirteen months after, she had lung MTS and then brain MTS. The patient died thirty months after the mastectomy. The surgeons have to discover the women high-risk for the breast cancer before and during the pregnancy. Excisional biopsy is the diagnostic procedure of choice for breast lump during pregnancy. When a breast cancer develops during a pregnancy, the surgeon has to operate immediately the tumors. Chemotherapeutic regimens should be delayed until the second o third trimester or after delivery.