Medullary carcinoma of the thyroid metastatic to breast.

Medullary carcinoma of the thyroid commonly spreads to the lymphatics and later on in the disease process, to distant sites such as lung, liver and bone. Spread to the breast is rare (only two previous reported cases) and presents a major diagnostic dilemma. We report a case of metastatic medullary carcinoma of the thyroid which presented as a primary breast nodule with ipsilateral axillary lymphadenopathy. Clearly it was important to distinguish this tumour from a breast primary as each are managed differently. Both cytological and radiological investigations were inconclusive but excision biopsy was diagnostic.     

Comparison of the clinical and pathological features between patients with recurrent metastatic breast carcinoma and patients with initially metastatic breast carcinoma

OBJECTIVE: To compare initial metastatic breast carcinoma (MBC) with recurrent MBC and assess their biologic phenotypes and clinical behaviors. METHODS: A comparison of clinical and biological characteristics and median overall survival times were assessed in the 251 patients with MBC at the Division of Medical Oncology, Ege University School of Medicine, and the Division of Radiation Oncology, Tepecik Government Hospital, Izmir, Turkey between 1995 and 2004. Hormone receptors, c-erbB-2, Ki-67, and p53 expressions were performed by immunohistochemistry. RESULTS: Out of 251 MBC patients, 206 patients had recurrent MBC, and 45 had initial MBC. Regarding survival, there was no difference between the recurrent MBC group and the initial MBC group. The initial MBC group had a higher proportion of T4 tumors (46% versus 27%), a lower proportion of T1-2 tumors (31% versus 55%; p=0.01), and a higher percentage of patients with high Ki-67 expression (64% versus 49%; p=0.05). Multivariate analysis showed that T stage was an independent prognostic factor (p=0.02). CONCLUSION: Patients with initial MBC tended to present with larger tumors. This relationship can be explained by delayed diagnosis. The potential for reducing death rates from breast cancer is contingent on educational improvement and increased screening rates.     

乳腺转移性胃印戒细胞癌1例

患者,女性,48岁,已婚.因左乳房包块于2004年12月30日入我科.入院前4个月,患者自觉出现双侧乳房胀痛不适,1周后,左乳出现瘙痒不适,并自觉乳房逐渐长大,局部伴有明显发热,入院前1个月,发现乳房包块并已经长大至鸡蛋大小,患者到当地中医院扎银针治疗,包块再次出现明显长大,入院前10 d,患者用中草药包敷1周后包块局部不再发烫.患者自入院前7个月,发现左上腹壁包块约黄豆大小,不痛,不痒,曾经扎银针治疗,无缩小,渐长大.近1年来,患者常有口吐酸水,无明显腹痛.饮食正常,月经正常.     

An autopsy case of breast carcinoma with prominent lipid-secretions in the metastatic foci

A 70-year-old woman was treated with a simple mastectomy followed by a course of 5000 rad to the breast and chemotherapy with 5-fluorouracil for breast cancer. About 15 months later, the patient died of widespread metastases. An autopsy revealed no recurrent cancer in the breast. The metastases were seen in bones (sternum, ribs and spine), pleura, spleen, uterus, ovaries, small intestine, adrenal glands, and lymph nodes (hilar, periaortic and mesenteric). Histologically, the resected tumor was a solid-tubular carcinoma with an infiltrative growth pattern. At autopsy, the tumor cells in the metastatic foci contained an abundance of lipids in the cytoplasm, while the tumor cells in the primary tumor contained small amounts of lipids.     

乳腺癌的原发与转移癌中P~(53)蛋白表达的相关性

目的　探讨P53 突变蛋白在乳腺癌原发灶与转移灶中表达差异与其侵袭性之间的关系。方法　用免疫组化ABC法检测了 42例乳腺原发癌与转移癌石蜡切片中 ,P53 蛋白表达情况。结果　乳腺癌P53蛋白的异常表达率为 5 9.5 2 % (2 5 /4 2 )。原发组阳性率为 45 .45 % (10 /2 2 ) ,转移组 75 .0 0 % (15 /2 0 )。≥ 45岁组阳性率 80 .0 0 % (16 /2 0 ) ,<45岁组 40 .91% (9/2 2 )。P53 蛋白表达在乳腺原发癌及转移癌间有显著差异(P <0 .0 5 ) ,与年龄亦显著相关。结论　乳腺原发癌与转移癌之间有明显异质性。     

Bilateral primary breast lymphoma

Pprimary breast lymphoma （PBL） is rare, accounting for 0.04%-0.50% of breast malignancies and 1.7% of extranodal lymphoma The originally descnibect diagnostic criteria for PBL2 remains the standard definition for this disease. These criteria are breast location as the clinical site of presentation, absence of history of previous lymphoma or evidence of widespread disease at diagnosis, close association of lymphoma with breast tissue in pathologic specimens, and involvement of ipsilateral lymph nodes if they develop simultaneously with PBL.     

Gut metastasis from breast carcinoma

Breast cancer is the second most common malignancy in women. Common sites of metastases include the liver, lung, bone, and the brain. Metastases to the gastrointestinal tract are rare with patients presenting with small-bowel perforation, intestinal obstruction, and gastrointestinal bleeding. Here we report a case of a Saudi female presenting with invasive lobular carcinoma and ileo-cecal junction metastasis.