A case of ectopic breast cancer with a literature review

A 63-year-old woman was referred to our hospital because of a right axillary nodule in 2004. Physical examination showed a spherical nodule measuring 0.5 cm in diameter in the right axilla. No mass was palpable in either breast. Mammograms were normal. Ultrasonography revealed a subcutaneous hypoechoic mass 0.7 mm in maximum diameter in the right axilla. The patient underwent an excisional biopsy. Histological examination revealed an invasive ductal carcinoma (scirrhous carcinoma) in ectopic breast tissue. The patient subsequently underwent a wide local excision of the tissue surrounding the biopsy scar, with axillary lymph node dissection. Histologically, no residual tumor or nodal metastasis was found. Postoperatively, she received endocrine therapy and remains well, without any evidence of recurrence 4 years 10 months after operation. Cancer of the ectopic breast tissue is rare, and most cases present as a solitary axillary mass. Long-term outcomes remain unclear. We present a case of breast carcinoma in the axillary ectopic mammary gland and summarize the clinical features of 94 cases, including ours, in Japan. We also compare long-term survival between ectopic breast cancer and usual breast cancer according to TNM T stage and lymph node metastasis.     

Ectopic breast cancer: Two case reports and review of the Japanese literature

Two cases of carcinoma involving ectopic breast tissue are reported, along with a review of the Japanese literature. A total of 65 cases of ectopic breast cancer have been reported; 59 of which occurred in the axilla. Total mastectomy with axillary dissection was performed in 29 cases, and tumor excision with or without nodal dissection was done in 30 cases. Outcome was known in 33 cases, and 5 cases had recurred at the time of this writing. Although the prognosis of ectopic breast cancer was difficult to establish with the limited follow-up data, all the 5 cases in our series with recurrence had axillary lymph node metastases at the time of surgery. Therefore, the complete excision of ectopic breast tissue with nodal dissection, and subsequent chemoendocrine therapy, especially in node-positive patients, is recommended as the treatment of choice.     

Phyllodes tumor arising in ectopic breast tissue of the axilla

We examined a 31-year-old woman with a solid mass in her left axilla. Physical examination and ultrasonography confirmed a 2 cm well-defined mass. Fine needle aspiration biopsy suggested fibroadenoma of breast. Excisional biopsy revealed benign phyllodes tumor of the ectopic breast tissue. Phyllodes tumor in ectopic breast tissue is an extremely rare occurrence. Only nine cases have been reported, including tumors of the vulva, inguinal region and axilla. This is the second case in the axillary region.     

男性乳腺癌18例治疗分析

目的 :探讨男性乳腺癌的治疗方法。方法 :对 1980年 10月～ 1993年 10月收治的 18例男性乳腺癌的临床资料进行回顾性分析。结果 :3例扩大根治术 ,11例根治术 ,3例简化根治术 ,1例单纯肿块切除 ,腋窝淋巴结转移阳性者 11例 ,占 61 1%。术后放疗者 14例 ,放疗 化疗者 11例 ,化疗 内分泌治疗者 9例 ,单纯内分泌治疗者 2例。Ⅰ期病例 5年内无死亡 ,总 5年生存率为 66 7%。结论 :以根治术为主 ,辅以放疗、化疗、内分泌治疗的综合治疗是男性乳腺癌治疗的较理想方法     

副乳腺浸润性导管癌1例并文献复习

目的：探讨副乳腺癌的诊断、鉴别诊断以及治疗方法。方法：报道腋窝副乳腺浸润性导管癌1例,结合文献对副乳腺癌的特点、临床表现、诊断、鉴别诊断、治疗以及预后进行探讨。结果：副乳腺癌的发病率较低,结合临床表现、镜下观察及免疫组化方法,可以明确诊断。注意与乳腺腋尾部癌、皮肤附件来源的肿瘤、腋下淋巴结转移癌、腋下淋巴结淋巴瘤等疾病进行鉴别诊断;治疗原则基本等同于乳腺癌的治疗。其预后较差,术后积极放化疗,有可能改善预后。结论：副乳腺癌相对少见。有副乳腺症者应加强自检,做到早期发现早期治疗。新辅助化疗联合手术治疗对提高患者的生存率很重要。     

Carcinoma originating from aberrant breast tissue. A case report and review of the literature

Carcinoma arising from ectopic breast tissue, either supernumerary breast or aberrant breast tissue, is extremely rare. Carcinoma occurs more frequently in the ectopic breast tissue of the axilla than in extra-axillary ectopic breast tissue. Here we report a case of an invasive lobular carcinoma arising from extra-axillary ectopic breast tissue and presenting as a subcutaneous nodule.     

Postirradiation sarcoma (malignant fibrous histiocytoma) of axilla.

A case is reported of a patient who developed a histologically unusual sarcoma in the axilla and chest wall 8 years after receiving radiation therapy (6500 rad) for carcinoma of the breast. This sarcoma showed light- and electron-microscopic features of a malignant fibrous histiocytoma, a tumor not documented among 24 previously reported cases of postirradiation sarcoma following the diagnosis of breast carcinoma. In addition, the literature is reviewed and discussed regarding postirradiation sarcoma in general following breast carcinoma.     

Primary ectopic breast cancer presenting as a vulvar mass

Ectopic breast tissue is found along the primitive embryonic milk lines, which extend from the axilla to the groin. Rarely, its occurrence has been described in the vulva. We report a patient who developed primary adenocarcinoma of ectopic breast tissue in such a location and present a review of the pertinent medical literature. The predominant pathology is that of invasive ductal carcinoma; however, other tumor types have also been reported in accessory breast tissue. Its treatment usually entails surgical resection with lymph node dissection. Adjuvant therapy should be guided by the same principles as in orthotopic breast carcinoma.     

Non-metastatic locally advanced cancer of the breast treated with radiation

One hundred forty-seven female patients with retrospectively classified (AJCCS 1977) Stage III and nonmetastatic noninflammatory Stage IV breast carcinoma from June 1958 to December 1978 were studied to determine the effects of primary radiation on local recurrence and survival. Fifty-one patients recurred in the breast; 24 patients recurred in the local-regional area of breast and draining lymphatics and 15 patients recurred in the axilla only. Distant metastases developed in 97 patients. The 5 year actuarial survival was 24%. Decreased recurrence rates were associated with megavoltage and higher doses of radiation (34% vs. 65%); with smaller tumors (27% vs. 57%); with total extirpation of gross tumor (33% vs. 53%); and with those tumors that were given a "boost dose" (26% vs. 58%). The addition of systemic treatment did not appreciably alter either local-regional recurrence or survival. However, most of the patients received endocrine ablation or single-agent chemotherapy. Polyagent chemotherapy was used late in the series, making its true impact on survival difficult to evaluate.     

Expression and co-expression of the members of the epidermal growth factor receptor (EGFR) family in invasive breast carcinoma

The epidermal growth factor receptor (EGFR) family plays an important role in breast carcinogenesis. Much interest has been focused recently on its members because of their potential role as prognostic indicators in breast cancer and their involvement in cancer therapy. We have evaluated more than 1500 cases of invasive breast carcinoma immunohistochemically using tissue microarray technology to examine the expression of EGFR family receptor proteins. We have found that 20.1 and 31.8% of cases were positive for EGFR and c-erbB-2, respectively, and 45 and 45.1% of tumours overexpressed for c-erbB-3 and c-erbB-4, respectively. The expression of either EGFR or c-erbB-2 was associated with other bad prognostic features and with poor outcome. Neither c-erbB-3 nor c-erbB-4 had any association with survival. c-erbB-2 had an independent prognostic effect on overall and disease-free survival (DFS) in all cases, as well as in the subset of breast carcinoma patients with nodal metastases. Several hetero- and homodimeric combinations have been reported between the EGFR members. Those dimers can evoke diverse signal transduction pathways with variable cellular responses. We stratified cases according to their co-expression of receptors into distinct groups with different receptor-positive combinations. Patients whose tumours co-expressed c-erbB-2 and c-erbB-3, as well as those whose tumours co-expressed EGFR, c-erbB-2 and c-erbB-4 showed an unfavourable outcome compared with other groups, while combined c-erbB-3 and c-erbB-4 expression was associated with a better outcome. In cases showing expression of one family member only (homodimers), we found a significant association between c-erbB-4 homodimer-expressing tumours and better DFS. In contrast, patients with c-erbB-2 homodimer-expressing tumours had a significant poorer DFS compared with other cases. These data imply that the combined profile expression patterns of the four receptor family members together provide more accurate information on the tumour behaviour than studying the expression of each receptor individually.     

40例男性乳腺癌随访资料分析

背景与目的 :探讨男性乳腺癌的临床特点 ,治疗方法和影响预后的因素。 材料与方法 :回顾性总结40例男性乳腺癌的临床特点和治疗方法 ,分析其影响预后的因素。 结果 :全部病例经手术后病理检查确诊。全组患者治疗后的5、10年生存率分别为65 %、52.5 %。根治术与改良根治术患者的5、10年生存率分别为72.2 %、71.4 %。腋窝部淋巴结转移率为62.5 %。 结论 :男性乳腺癌比女性病程长 ,更具有激素依赖性。容易发生腋窝淋巴结转移 ,预后较差。治疗上首选改良根治术并根据不同情况辅以放疗、化疗和内分泌治疗。     

Radiation treatment of superior sulcus lung carcinoma

The survival of patients with superior sulcus lung carcinoma and the effects of treatment were reviewed. From a prospective database of 4123 consecutive new patients with lung carcinoma, 131 (3.2%) cases of superior sulcus lung carcinoma were identified. Seventy-four patients were planned to receive radiation with palliative intent, 53 radical radiotherapy and one was observed only. The remaining three patients, with small-cell carcinoma, were treated with chemotherapy with or without radiotherapy. Of the 53 radically treated patients, nine were treated with pre-operative radiation prior to intended radical resection. Analysis was carried out on the effect on survival of performance status, nodal involvement, weight loss, vertebral body or rib involvement, treatment intent and radical combined modality treatment compared with radical radiation alone. The estimated median survival for the whole group was 7.6 months; for those treated radically it was 18.3 months, while for the palliatively treated patients it was 3.7 months. Radically treated patients with no initial nodal involvement had an estimated median survival of 22 months, while radically treated patients with nodal involvement had an estimated median survival of 8.4 months (P= 0.003). There were no statistically significant differences in survival between radically treated patients grouped according to initial weight loss, performance status, or vertebral body and rib involvement. Patients treated with pre-operative radiation did not survive significantly longer than patients treated with radiation alone, although the numbers are small.     

颈段食管癌治疗方法的探讨

分析 1 70例颈段食管癌 ,以探讨颈段食管癌的治疗方案。术前放疗加手术综合治疗 30例 ,单纯手术 2 7例 ,单纯放疗 1 1 3例 ,术前放疗剂量为DT4 0Gy/4周 ,疗后 3个月内行手术 ,单纯放疗剂量为DT5 0Gy/5周以上 ,综合治疗、单纯手术与单纯放疗其 5年生存率分别为 4 0 .0 %、1 5 .3%与 2 8%。综合治疗与单纯手术间有统计学差别 (P <0 .0 5 ) ,且并发症发生率、手术有关死亡率相似。颈淋巴结转移是影响单纯放疗预后的重要因素 ,单纯放疗主要失败原因为局部未控复发 ( 71 .0 % ) ,综合治疗主要失败原因为淋巴结转移 ( 81 .0 % )。我们认为综合治疗能提高颈段食管癌的生存率 ,而根治性单纯放疗也是主要的治疗方法之一。术前放疗剂量 ,在食管局部为DT4 0Gy/4周 ,双下颈锁骨上预防时为DM4 5～5 0Gy ,有淋巴结转移时应给予DM5 0Gy以上 ,同时行淋巴结转移侧颈清扫术。     

局部晚期乳腺癌改良根治术后多西他赛同步放化疗的放射性不良反应观察*

目的:对比观察局部晚期乳腺癌改良根治术后多西他赛同步放化疗与序贯放疗的放射性不良反应,评估多西他赛同步放化疗模式的安全性、可行性。方法:收集2009年1 月至2014年12月广西医科大学第四附属医院155 例女性乳腺癌病例,患者均行乳腺癌改良根治术,病理诊断为乳腺浸润性导管癌,TNM 分期为pT3～4pN1～3cM0 或p 任意TpN 2～3cM0。采用氟尿嘧啶+ 表柔比星+ 环磷酰胺（FEC ）化疗方案后,密闭信封法随机分为同步组（多西他赛化疗时同步放疗）78例、序贯组（多西他赛化疗完成后放疗）77例,观察两组放射性不良反应及近期疗效。结果:中位随访39（16～62）个月。同步组和序贯组的放射性不良反应轻微,均无3～4 级放射性皮肤反应、症状性心肺放射损伤。1～2 级放射性皮肤反应同步组的发生率为89.7%（70/ 78）、序贯组为88.3%（68/ 77）,两组比较差异无统计学意义（P > 0.05）。 3 年无复发生存率同步组为92.3%（72/ 78）,序贯组为81.8%（63/ 77）,两组比较差异具有统计学意义（P = 0.046）。 结论:局部晚期乳腺癌改良根治术后多西他赛同步放化疗的放射性不良反应轻微,与序贯治疗比较提高了患者的3 年无复发生存率,安全可行,可作为局部晚期乳腺癌的治疗选择。      

A case of carcinoma originating from accessory breast tissue of the axilla

We report a case of carcinoma originating from accessory breast tissue of axilla and review 33 reported cases of carcinoma in heterotopic breast tissue. Although the incidence of accessory breast cancer is not high, early diagnosis and treatment are necessary, keeping in mind the possibility of this carcinoma when subcutaneous nodules of uncertain origin are found around the breast. Surgical treatment which must at least include wide local extirpation including the surrounding tissues and dissection of the axillary lymph nodes is necessary and adjunctive chemotherapy and irradiation appear to be useful.     

Adenocarcinoma arising in vulvar breast tissue

A patient with adenocarcinoma arising in vulvar ectopic breast tissue is described. Hormonal receptors of the tumor are analyzed. This is the first case in which an intensive treatment with combined surgery, radiation, hormonal therapy, and cytotoxic chemotherapy was given. Five cases reported previously in the literature are reviewed.     

Current status of radiation in the treatment of breast cancer

Radiation therapy in combination with lumpectomy and axillary dissection has remained standard therapy for early-stage disease since the 1970s. Although there has been no definitive trial in patients with ductal carcinoma in situ, the data suggest that excision plus radiation therapy is a viable option. The local management of early-stage breast cancer includes modified radical mastectomy, with or without reconstruction, or breast-conserving therapy. Six prospective randomized trials compared mastectomy with breast-conserving therapy, and all have shown equivalent survival. Despite efforts to identify subgroups of patients with invasive disease who do not require breast irradiation, based on current data, this modality remains standard treatment after conservative surgery in all patients. Ongoing multicenter studies may clarify the role of brachytherapy, which may provide advantages in some patients after breast-conserving therapy. Axillary radiation is a viable option for patients who fail to undergo sampling of the axilla and may be a future option for patients who have a positive sentinel node but no further dissection. The ability of postmastectomy radiation to affect survival has long been controversial.     

男性乳腺癌50例临床病理分析

 我院自1954年到1989年底共手术治疗50例男性乳腺癌，占同期经治可手术全部乳腺癌7050例的0.71%。其中Ⅰ期8例，Ⅱ期21例，Ⅲ期20例及原发双侧者1例（右侧Ⅱ期，左侧Ⅲ期）。行扩大根治手术者6例，传统根治手术者31例，改良根治术者6例，全乳切除者5例（原发双侧者两侧均行全乳切除术，按1例计算）及局部切除术者2例。本组病例的5年生存率为78．7%，10年生存率为31．6%。本研究同时对男性乳腺癌的发病及预后因素进行了探讨。     

横切口下保留肋间臂神经在乳腺癌术中的临床价值

目的:探讨横切口下保留肋间臂神经（ICBN）在乳腺癌术中的临床应用价值。方法:将63例Ⅰ、Ⅱ期乳腺癌患者分为实验组（保留ICBN），对照组（切断ICBN）。 随访观察术后患侧上臂内侧感觉功能。结果:随访第1、6、12个月期间未见癌肿复发、转移。实验组中，术后患侧上臂内侧及腋部皮肤感觉正常29例（87.88%），感觉异常4 例（12.12%）；而对照组30例患者均有感觉异常。结论:在乳腺癌改良根治术中，保留ICBN 可明显减少术后患侧上臂内侧感觉障碍的发生率，有助于提高患者的生存质量。