Bilateral Orbital Metastases as the Presenting Finding in a Male Patient with Breast Cancer: A Case Report and Review of the Literature

Abstract: Breast cancer in men has traditionally been thought to be substantially different from that in women. As more becomes known about this relatively rare entity, the similarities between genders become more striking than the differences. Carcinoma of the male breast is an uncommon disease occurring in less than 1% of all breast cancers. Male breast carcinoma is staged similarly to female breast cancer using the American Joint Committee Clinical Staging System. As in women, axillary nodal status is the strongest predictor of outcome. Distant metastasis to bones, soft tissue, lungs, and liver have been widely reported in men with breast cancer. This case report provides a rather rare presentation of a man with breast carcinoma with bilateral orbital metastasis as an initial clinical presentation.     

Extended Adjuvant Endocrine Therapy in Breast Cancer: Evidence and Update — A Review

The optimal duration and treatment strategies involving adjuvant endocrine therapy in early breast cancer remained largely undetermined. As data emerge on the various modalities of treatment in both pre‐ and postmenopausal groups, debates, and discussions continue. Most studies to date focused on the 5‐year duration of treatment consisting of mainly tamoxifen. The Arimidex, Tamoxifen, Alone or in Combination (ATAC) study demonstrated that anastrozole is superior to tamoxifen and has become the mainstream treatment in postmenopausal women with early breast cancer, although the duration was arbitrarily set for 5 years, analogous to tamoxifen treatment. Several clinical trials, however, have emerged to support extended endocrine therapy as it becomes clear that the recurrence risk of breast cancer does not decrease beyond the initial 5 years of treatment. The advent of molecular signatures also plays an important role in the breast cancer profiling, and where available should be incorporated in the overall decision‐making. Furthermore, side effects and noncompliance pose another issue in achieving an optimal treatment benefit. The decision‐making as regards to extended endocrine treatment should therefore focus not only on the cancer biology alone but also include treatment side effects, assessment of risk of recurrence and patients' preference. In this review, we present an overview of the published studies to date as well as ongoing studies on the topic to better refine the options for adjuvant hormonal therapy.     

乳腺癌内分泌治疗后潮热的中医治疗概况

潮热是乳腺癌内分泌治疗过程中常见的不良反应,严重影响了患者的生活质量,降低了治疗的依从性.笔者通过查阅文献及临床观察发现,阴阳失调是潮热出现的基本病机,与肝、肾、心三脏脏腑阴阳失衡密切相关,可将其分为肝郁气滞证、肝肾阴虚证、心肾不交证、营卫不和证,治法以疏肝、滋肾、养心为主,辅以调和营卫以治其标;外治法如针灸、耳穴、脐...     

Pleomorphic Liposarcoma of the Breast Mimicking Breast Abscess in a 19‐Year‐Old Postpartum Female: a Case Report and Review of the Literature

Abstract: Sarcomas of the breast constitutes <1% of primary malignant breast tumors. Liposarcoma of the breast represents 3–24% of the primary breast sarcomas. Liposarcoma can arise from pre‐existing benign lesions like fibroadenoma or from lipoid tissue in the breast. There are only few cases of liposarcoma of the breast in young females reported in the literature. Liposarcoma of the breast typically involves women with age after 50 years. In this article, we present a young woman with liposarcoma of the breast.     

Breast Carcinoma in Childhood and Adolescence: Case Report and Review of the Literature

Secretory breast carcinoma is a rare tumor originally described in children and adolescent women with a characteristic morphology and a controversial choice of treatment. We report an additional case of a 4-year-old girl with a breast tumor diagnosed as a secretory carcinoma without involvement of the axillary lymph nodes. The therapy consisted of simple mastectomy and low axillary dissection. She presented with a local recurrence near the surgical scar 8 months later, and a wide elliptical excision of the scar and underlying tissue was performed with subsequent radiotherapy of the surgical bed. This tumor has a relatively benign behavior and rarely metastasizes. A literature review revealed only 22 cases of breast carcinoma in childhood and adolescence. ▪     

Efficacy of Anastrozole in a Consecutive Series of Advanced Breast Cancer Patients Treated with Multiple Prior Chemotherapies and Endocrine Agents: M. D. Anderson Cancer Center Experience

▪  Abstract: Anastrozole is a highly selective, nonsteroidal aromatase inhibitor approved by the U.S. Food and Drug Administration (FDA) in January 1996 for the treatment of advanced breast cancer in postmenopausal women with disease progression following tamoxifen therapy. To date, information on anastrozole's use has been limited to breast cancer patients with minimal prior therapy. The purpose of this review was to determine, in clinical practice, the benefits of anastrozole in advanced breast cancer patients treated with multiple prior cytotoxic and endocrine therapies. This was a retrospective review of a consecutive series of 117 patients who received anastrozole after marketing in January 1996. As this was not a prospective study, rigorous response criteria could not be applied. Responses were categorized as improvement in disease (ID), stable disease (SD), or progressive disease (PD). One hundred eight patients were evaluable for response with a median age of 61 years and the number of prior therapies ranging from one to nine. Response, defined as improvement of disease or stable disease 8 weeks, was seen in 59% of patients. Patients with three or more prior endocrine therapies demonstrated a 61% response (ID + SD) and patients with ER-negative tumors demonstrated 50% response. Patients with prior aminoglutethamide therapy exhibited similar response rates to the overall group. One male patient received anastrozole without benefit. This data determines the activity of anastrozole even in heavily pretreated patients and suggests that patients who have tumors that are ER-negative may also benefit from anastrozole therapy. ▪     

A Case of a Bilateral Inflammatory Breast Cancer: A Case Report

Cases of bilateral inflammatory breast cancer (IBC) are extremely rare. Our search criteria only found one other record of metachronous bilateral IBC (1). We present the case of a patient who was treated for IBC with neoadjuvant chemotherapy, modified radical mastectomy (MRM), and whole breast radiation. Less than 1 year later, the patient had a recurrence of IBC on the left chest wall with in the radiated field, as well as a new IBC on the contralateral side. Bilateral IBC is extremely rare. This entity can present challenges for the standard treatment of IBC with neoadjuvant chemotherapy, MRM, and whole breast radiation (2). Our case study shows the importance of scheduled routine imaging, screening with physical examination after IBC management, and good patient compliance in this aggressive disease (3).     

Breast Necrosis after Chemotherapy for Recurrent Ovarian Cancer: Report of a Case and Review of the Literature

Breast necrosis is a rare event due to abundant blood supply of the breast. We present an unusual case of partial breast necrosis after chemotherapy for recurrent ovarian cancer. Necrotic tissue sloughed with conservative management and the wound was repaired surgically. We believe that this is the first case report of breast necrosis as a systemic complication of chemotherapy.     

Clinical Features and Treatment Response of Solid Neuroendocrine Breast Carcinoma to Adjuvant Chemotherapy and Endocrine Therapy

Solid neuroendocrine breast carcinoma (solid NEBC) is a relatively uncommon malignant tumor of the breast. The purpose of our study was to explore the incidence and clinical features of this tumor, and to evaluate the efficacy of adjuvant chemotherapy and endocrine therapy for patients with solid NEBC. Of 7542 breast cancers registered during the period from March 2004 to April 2011, 22 patients (0.29%) who underwent surgery had tumors that were histologically confirmed as solid NEBC, and were enrolled in this study. The age range of these patients was 29–77 years (mean 52.5 years). Patients were staged according to the 7th edition of the pathologic tumor‐node‐metastasis (pTNM) staging system. Biopsies or resection specimens were reviewed and reclassified according to the World Health Organization (WHO) 2003 classification. We recorded clinical features including gender and age, chief complaint, and past medical history, tumor characteristics including size, location, preoperative diagnosis, and pathologic and immunohistochemical findings, the therapeutic schedule, and the follow‐up results. Solid NEBC is a rare and distinct category of malignant disease of the breast, with good prognosis, and in most early‐stage cases, is resectable. The role of adjuvant chemotherapy and endocrine therapy in solid NEBC may be limited and should be studied further.     

Shortened Radiation Therapy Schedules for Early‐Stage Breast Cancer: A Review of Hypofractionated Whole‐Breast Irradiation and Accelerated Partial Breast Irradiation

Breast‐conserving therapy consisting of segmental mastectomy followed by whole‐breast irradiation (WBI) has become widely accepted as an alternative to mastectomy as a treatment for women with early‐stage breast cancer. WBI is typically delivered over the course of 5–6 weeks to the whole breast. Hypofractionated whole‐breast irradiation and accelerated partial breast irradiation have developed as alternative radiation techniques for select patients with favorable early‐stage breast cancer. These radiation regimens allow for greater patient convenience and the potential for decreased health care costs. We review here the scientific rationale behind delivering a shorter course of radiation therapy using these distinct treatment regimens in this setting as well as an overview of the published data and pending trials comparing these alternative treatment regimens to WBI.     

Impact of Oncotype DX on Treatment Decisions in ER‐Positive,Node‐Negative Breast Cancer with Histologic Correlation

Oncotype DX, a gene‐expression profiling assay, provides stratification of patients with estrogen‐receptor positive, lymph‐node‐negative early breast cancer into risk groups based on recurrence score, which are associated with distant recurrence and response to chemotherapy. This study aims to determine whether Oncotype DX influences clinicians' treatment decisions, and whether assay results correlate with histologic assessment. Fifty patients with estrogen‐receptor positive, node‐negative early breast cancer analyzed by Oncotype DX and operated on by two breast surgeons were included. To assess effect on treatment decisions, clinical vignettes were created by retrospective chart review. Physicians were then presented with the clinical vignettes and instructed to make a treatment decisions (i.e., hormone therapy alone versus hormone therapy combined with chemotherapy) both before and after knowledge of the recurrence score. To assess correlation with histologic assessment, a prospective, blinded review of tumor slides was performed by two pathologists. Based on this review, tumors were placed into low, intermediate and high risk groups for comparison with Oncotype DX assay results. Treatment decisions were changed based on Oncotype DX results in 36 and 18% of cases by breast surgeons and medical oncologists, respectively. All tumors categorized as high risk by Oncotype DX were categorized as high risk based on histologic assessment, and 96% of cases categorized as low risk by recurrence score were categorized as low or intermediate risk by histologic assessment. Oncotype DX significantly influences management of estrogen‐receptor positive, lymph‐node‐negative early breast cancer. Further studies are needed to assess association of histologic categorization to assay results.     

Simultaneous Bilateral Breast Cancer in a Male: a Case Report and Review of the Literature

A 63-year-old male presented with a bilateral breast carcinoma. Both axillae showed metastases. The patient was treated with a bilateral modified breast amputation. Study of the literature shows that synchronous bilateral breast cancer in males is uncommon. Even in a male with changing breast tissue a carcinoma has to be considered. In male breast cancer, adherence to diagnostic and treatment guidelines for female breast cancer is generally advocated. In males, hormonal causes have to be excluded.     

Angiosarcoma of the Breast Following Lumpectomy and Radiation Therapy for Breast Carcinoma: Case Report and Review of the Literature

Abstract: A case of angiosarcoma of the breast following lumpectomy and radiotherapy is described. A search of the literature found this entity to be first described in 1987. Thirty-two additional cases were found, one of which was bilateral in the same patient. The goal of this paper is to highlight the clinical presentation, diagnosis, and treatment of this problem. Heightened awareness of this condition is critical to those who provide long-term follow-up care for women treated with breast preservation for breast cancer.
The average age of diagnosis of the breast carcinoma was 62 years. The average latency interval to the development of angiosarcoma was 69 months, shorter than angiosarcoma following radiotherapy to other anatomic sites. Accepted treatment is simple mastectomy. No correlation between dosage of radiotherapy, site of angiosarcoma development, or use of a boost dose was found. Seventeen patients recurred; not all had adequate follow-up data. Of those that did, there are 7 that survived between 9 and 36 months after first recurrence. Eight died either of or with recurrent angiosarcoma.
One of the shortcomings of case report literature is lack of adequate follow-up. Conclusions about prognosis following a diagnosis of angiosarcoma after breast conservation is greatly limited by this. However, aggressive therapy even after recurrence of angiosarcoma appears to be of benefit in at least a subset of patients. Breast cancer treated conservatively is gaining favor, and cases of angiosarcoma of the breast as a complication of it are likely to increase as well. The true incidence and short- and long-term prognosis will remain elusive unless a registry of this complication is established.     

Clinicopathologic features of hormone‐receptor‐positive breast cancer patients with late recurrence

The number of long‐term breast cancer survivors with a risk of late recurrence is increasing. Hormone‐receptor‐positive patients have greater risks of late recurrence. Although several studies demonstrated that extended adjuvant endocrine therapy reduces the incidence of late recurrence, it remains unclear which hormone‐receptor‐positive patients have greater risks of late recurrence. Hormone‐receptor‐positive breast cancer patients were retrospectively selected from the prospective database of primary breast cancer patients treated at Keio University Hospital from January 1989 to December 2003. Late recurrence was defined as initial recurrence after 5 years from the initial surgery. We evaluated the clinicopathologic features of breast cancer patients with late recurrence. At a median follow‐up of 10.9 years (range, 5.1‐23.8), 371 patients had no recurrence, 90 had early recurrence (within 5 years), and 83 had late recurrence. Multivariate analysis revealed that >4 involved lymph nodes were significant risk factors for late recurrence (P < .001), whereas 1‐3 positive nodes were not. Endocrine therapy significantly reduced the incidence of late recurrence (P < .001). After menopause, adjuvant therapy with aromatase inhibitors resulted in longer disease‐free survival than tamoxifen (10‐year disease‐free survival: 97.6% vs 89.7%, P = .0955). High nodal involvement was significantly correlated with late recurrence in hormone‐receptor‐positive breast cancer patients. Hormone‐receptor‐positive breast cancer patients who receive adjuvant endocrine therapy with tamoxifen alone might be candidates for extended endocrine therapy.     

Blue Lymphangitis of the Breast after Breast Cancer: Case Report

Carcinomatous lymphangitis accounts for 5% of all skin metastases, but blue lymphangitis of the breast has never been described. We report a case of blue lymphangitis of the breast in a patient 11 years after treatment for ipsilateral breast cancer that was in full remission. Breast examination and imaging showed no other abnormalities. Skin biopsy revealed a carcinomatous‐pigmented infiltration corresponding to melanoma metastasis, which helped highlight a primitive right flank injury. This case report emphasizes that a full body exam should always be performed with unusual presentation of breast cancer and reiterates the indispensable place of histology before any diagnosis.     

The Dilemma of Breast Cancer Treatment and Existing Collagen Vascular Disease: A Case of Scleroderma and Review of the Literature

Collagen vascular diseases present a treatment dilemma for patients with breast cancer. Due to the potential for severe, acute, and late complications of radiation therapy, a history of collagen vascular disease (CVD) is a relative contraindication to breast‐conserving treatment. We present a case of early stage breast cancer in a patient with severe scleroderma treated with breast‐conserving surgery without radiation and a brief review of the published literature regarding the therapeutic approach to the patient with CVD and breast cancer.     

Parotid Gland Metastasis of Breast Cancer: Case Report and Review of the Literature

BACKGROUND: Parotid gland metastasis in breast cancer is extremely rare, and only 14 cases have been reported between 1982 and 2010. CASE REPORT: A 67-year-old female patient was diagnosed with invasive lobular carcinoma of the left breast. Although clinical staging was T1N3M1 (stage IV), the tumor experienced a complete response to chemotherapy. We therefore performed a mastectomy followed by radiotherapy, and continued administration of trastuzumab. However, 11 months later, the patient complained of a swelling in the left parotid gland. Histology following a partial parotidectomy revealed a parotid gland metastasis from the breast. CONCLUSION: Treatment with capecitabine in addition to trastuzumab, which is one of the strategies applied in HER2-positive breast cancer, was effective in our patient. Analysis of the 14 cases of parotid gland metastasis from the breast reported between 1982 and 2010 revealed that the metastasis may occur not by direct lymphatic but by hematogenous spread.     

Adherence to Anti‐estrogen Therapy in Seniors with Breast Cancer: How Well are we Doing?

A third of breast cancers (BC) occur in women ≥65 years (seniors). Anti‐estrogen therapy (AET) significantly reduces BC recurrence and death. This study characterizes determinants of adherence to AET in seniors with BC. Provincial cancer registry and administrative claims data were accessed for all non‐metastatic BC diagnosed in Quebec (1998–2005) to identify seniors treated for 5 years with AET. Multivariate linear regression was used to assess the association with patient, disease, and physician characteristics and the 5‐year medication possession ratio (MPR) for each patient. 4,715 women were included (mean age: 72.9). Mean MPR was 83.5%, 79% of patients reached a 5‐year MPR of ≥80%, and 34% discontinued AET at some point during treatment. The cumulative probability of discontinuation was 33.8% (mean time to discontinuation 2.3 years). The MPR decreased with increasing age and non‐BC related hospitalizations, p < 0.05. Each new medication added during the 5‐years decreased the MPR by 0.3% (p < 0.05). Women with in situ disease, on antidepressants at baseline, or treated with Tamoxifen had a lower MPR by 6.5% (p = 0.0002), 4.7% (p = 0.003) and 6% (p = 0.001), respectively. Switching AET type was associated with a lower MPR by 5.3% (p = 0.002) if the switch occurred during the first year. Optimal 5‐year adherence to AET in seniors with BC remained a challenge and medication discontinuation rates were high. Advanced age, increasing number of hospitalizations, in situ disease, baseline use of antidepressants, Tamoxifen (versus aromatase inhibitors), early switches of AET type, and newly added medications significantly reduced the MPR.