Two Cases of Post-Radiation Sarcoma after Breast Cancer Treatment

We describe two cases of post-radiation sarcoma after breast cancer treatment. The first patient was a 61-year-old woman who underwent partial mastectomy of the right breast and adjuvant whole breast irradiation 7 years previously. Subsequently, a rapidly growing mass from the anterior arc of the right fifth rib was incidentally detected on an abdomino-pelvic computed tomography scan. The second patient was a 70-year-old woman who received neoadjuvant chemotherapy and a partial mastectomy of the left breast 9 years ago. Adjuvant irradiation was delivered to the whole breast and supraclavicular region. Subsequently, an approximate 8 cm mass developed in the left axillary area. Both patients received wide excision of the tumor with negative resection margins. The pathological diagnoses were osteosarcoma and undifferentiated pleomorphic sarcoma, respectively. Although post-radiation sarcomas are rare complications with a poor prognosis, enhanced awareness and early detection by clinicians are essential to improve outcomes via curative surgical resection.     

Cardiac Sarcomas: An Update

Primary cardiac sarcomas are rare and represent 20% of all primary cardiac tumors. Symptoms depend on the chambers and the cardiac structures involved. Transthoracic echocardiography is commonly used to identify a cardiac mass. The diagnosis of cardiac sarcoma requires adequate sampling and the careful use of ancillary diagnostic techniques. In the most recent histologic classification, angiosarcoma is the most common malignant tumor of the heart with recognizable differentiation. Undifferentiated sarcomas account for one-third of all cardiac sarcomas and have been incorporated in the malignant fibrous histiocytoma/pleomorphic sarcoma subgroup. Elective cardiac sarcoma therapy includes complete surgical excision when possible, followed by radio and chemotherapeutic regimen, the latter preferably containing anthracyclines, ifosfamide, or taxanes. Prognosis of cardiac sarcomas is very poor, with mean survival ranging from 9.6 to 16.5 months. A less-aggressive course seems related to the left atrium location, a low histologic grading with scarce cellular pleomorphism and low-mitotic activity, absence of necrosis, myxoid tumor appearance, and absence of metastasis at diagnosis.     

Undifferentiated Pleomorphic Sarcoma Invading the Internal Jugular Vein

A 60-year-old woman received carbon ion radiotherapy (C-ion RT) (70.4 Gy [relative biological effectiveness]/16 fr) for undifferentiated pleomorphic sarcoma (UPS) (T4bN0M0) in the left pterygopalatine fossa. After 26 months, left parotid resection and left neck dissection were performed for lymph node metastasis in the left parotid gland (no irradiation field). Pathological findings revealed a lymph node with UPS metastasis in the left parotid gland. However, no other metastases in the left cervical lymph node or vascular invasion were observed. Four months after surgery, magnetic resonance imaging revealed an invasion of the left internal jugular vein. Pathological examination of the vascular lesion was not possible because the patient did not consent to surgery. Undifferentiated pleomorphic sarcoma most commonly metastasizes to the lung, and there is currently no known report of vascular invasion. In this case, vascular invasion possibly developed due to changes in the perivascular tissues after the left neck dissection, which may have facilitated tumor invasion into the vascular wall. Based on the images and the clinical course, a rare condition for vascular invasion from UPS recurrence was considered.     

Sarcoma embrionario indiferenciado hepático en niños. Presentación de dos casos clínicos

Undifferentiated embryonal hepatic sarcoma is the third most frequent malignant hepatic neoplasm in children. We describe two cases of school age who presented with dyspnea, weight loss, epigastric pain and a large palpable mass in the right hepatic lobe in the absence of tumor markers. An ultrasound showed a solid mass and the computed tomography, mixed well limited cystic images. Surgical treatment was a right hemihepatectomy and the use of chemotherapy. An undifferentiated embryonal hepatic sarcoma is a diagnostic possibility in school age children presenting with large hepatic mass and negative tumor markers. The initial treatment is a complete tumor resection and chemotherapy in order to increase survival.     

High-grade soft tissue sarcoma arising in a desmoid tumor: case report and review of the literature

Desmoid tumors are rare benign monoclonal fibroblastic tumors. Their aggressiveness is local with no potential for metastasis or dedifferentiation. Here we report on a 61-year-old patient who presented a locally advanced breast desmoid tumor diagnosed 20 years after post-operative radiotherapy for breast carcinoma. After 2 years of medical treatment, a high-grade undifferentiated pleomorphic soft tissue sarcoma arose within the desmoid tumor. Despite extensive surgery removing both tumors, the patient showed locoregional relapse by the sarcoma, followed by multimetastatic progression, then death 25 months after the surgery. The arising of a soft tissue sarcoma in a desmoid tumor is an exceptional event since our case is the fourth one reported so far in literature. It reinforces the need for timely and accurate diagnosis when a new mass develops in the region of a preexisting desmoid tumor, and more generally when a desmoid tumor modifies its clinical or radiological aspect.     

Breast Cancer and Secondary Cancer Recurrences After Autologous Tissue Reconstruction

BackgroundThe medical literature defining breast cancer recurrence and secondary cancers after autologous tissue reconstruction for breast cancer is sparse. We sought to identify and analyze occurrences at our institution.Patients and MethodsA 20-year retrospective review of cancer recurrences and atypical breast neoplasms after autologous tissue breast reconstruction at Roswell Park Comprehensive Cancer Center was conducted after being granted a waiver from the institutional review board.ResultsEighteen locoregional recurrences among 337 cases were identified and analyzed. Overall recurrence rate was 5.3%. Four secondary cancers (1.2%) were radiation-induced angiosarcoma, undifferentiated pleomorphic sarcoma, and metaplastic carcinoma. One case of flat epithelial atypia was identified.ConclusionOur retrospective review found incidence and survival after treatment of breast cancer concordant with reports in the literature. We also identified and analyzed secondary neoplasms, including a unique case of undifferentiated pleomorphic sarcoma and metachronous recurrence of breast carcinoma. A case of recurrence as metaplastic carcinoma was identified.     

A case of carcinoma of the breast with squamous and cartilaginous metaplasia

A 40 year-old female underwent mastectomy for a rapidly growing left breast mass. Histologically, the tumor was composed of invasive ductal carcinoma with squamous metaplasia, a cartilaginous component and a pleomorphic sarcoma-like component. In each histologic feature, gradual transition was recognized. A diagnosis of carcinoma with metaplasia (squamous and cartilaginous type) of the breast was made. The cartilaginous component in this case is probably the result of direct cartilaginous metaplasia of carcinoma cells and cartilaginous metaplasia followed upon carcinoma cells into small undifferentiated tumor cells and pleomorphic sarcomatous cells.     

肾脏原发性未分化多形性肉瘤MSCT诊断及病理对照研究

目的:探讨肾脏原发性未分化多形性肉瘤的临床、病理特征及多层螺旋CT表现.方法:回顾性分析8例经病理证实的肾脏原发性未分化多形性肉瘤的临床病理资料及CT影像特征.结果:8例均为单发,左肾6例,右肾2例,5例病灶主体位于肾上极,3例位于肾下极.5例病灶主体位于肾实质,2例侵犯肾窦,1例主体位于肾窦.5例伴有同侧不同程度肾积水,2例伴有明显肾周侵犯,1例肾静脉癌栓形成.7例形态不规则、边界不清,1例类圆形、边界清晰.CT平扫均表现为不均匀等/低混杂密度,1例病灶内可见斑点状、结节状钙化;增强扫描8例皮质期均表现为不均匀轻至中度强化,强化程度低于肾皮质;6例实质期、肾盂期持续强化,2例强化程度下降.结论:肾脏原发性未分化多形性肉瘤易误诊,CT增强扫描有一定的特征性,主要依靠病理和免疫组化确诊.     

Myeloid metaplasia of the breast

Hereby, we present the case of a 50-year-old woman with 5-year history ofchronic idiopathic myelofibrosis who was referred to our institution after shehad noted a lump in the breast. Histological examination of the lesion removedfrom her left breast yielded the diagnosis of extramedullary hematopoiesis inthe breast. On the basis of our experience in this particular patient and onthe basis of the data in the literature, we discuss the value of differentmore or less invasive diagnostic procedures, such as sonography, mammography,fine needle aspiration biopsy and surgical excision with histologicalexamination of removed tissue in obtaining the diagnosis of myeloid metaplasiain breast.     

Radiation-induced undifferentiated pleomorphic sarcoma after radiation therapy for a desmoid tumour

Radiation-induced sarcoma is a long-term complication of radiation therapy. The most common secondary neoplasia is the undifferentiated pleomorphic sarcoma, which is usually described in the deep soft tissue of the trunk or extremities. Radiation-induced sarcomas have a poor prognosis. An early diagnosis and management are needed to improve the survival rate of such patients. We presently report a case of a radiation-induced undifferentiated pleomorphic sarcoma of the left gluteus maximus muscle, which developed 25 years after an initial diagnosis of aggressive fibromatosis and 21 years after a tumour recurrence. This case study illustrates the risk of developing a sarcoma in a radiation field and the need for long-term follow-up after radiation therapy. Unnecessary radiation therapy, in particular in the case of benign conditions in young patients, should be avoided.     

Primary pleomorphic sarcoma of the liver

A 35-year-old woman presented with abdominal distension and a palpable liver mass. Ultrasonography and computed tomography revealed a large well-delineated liver mass with bilobar involvement. Based on autopsy and immuno-histochemical findings, a final diagnosis of primary pleomorphic liver sarcoma with myogenic differentiation was established.     

Bilateral angiosarcoma of the breast detected by magnetic resonance imaging during pregnancy

Angiosarcoma of the breast is an aggressive malignancy of endothelial origin with a tendency for localregional recurrence. The involvement of angiosarcomas in the bilateral breasts has rarely been documented. Of note, due to its rarity and typically unclear clinical findings upon examination, the diagnosis of a contralateral lesion can be difficult, particularly in women during pregnancy. Here we present a rare case of bilateral angiosarcoma of the breast during pregnancy. A 32-year-old woman was referred to our unit with complaints of progressive swelling of the left breast, with tenderness. Magnetic resonance imaging showed a small, circumscribed high-intensity area in the contralateral breast, with pattern similar to that of the lesion found in the left breast. The contralateral lesion revealed only equivocal findings with the other diagnostic modalities. Diagnosed as angiosarcoma preoperatively, excision of the bilateral tumors was performed. Histological findings of the removed bilateral tumors were compatible with high-grade angiosarcoma of the breast.     

超声引导下mammotome微创旋切乳腺肿块42例分析

目的:探讨mammotome微创旋切手术对乳房肿块的诊断和治疗价值。方法:对42例68处乳腺肿块进行了超声引导下mammotome微创旋切术,评价其诊断和治疗效果。结果:40处乳腺病灶为乳腺纤维腺瘤,19处为乳腺纤维腺瘤形成趋势,7处为乳腺腺病,2处术中诊断为乳腺囊肿,术后病理为纤维脂肪组织。67处病灶被切除,1处纤维腺瘤术中出血终止手术。1例单发纤维腺瘤处术后并发严重出血,1例术中机械故障顺利排除。皮肤切口3mm,每个病灶平均旋切28次,手术时间平均为30分钟。B超随访1~6个月无复发。结论:超声引导下mammotome微创旋切手术对乳腺良性病灶能明确诊断且切除彻底,皮肤疤痕小,美容效果好。     

Granular cell tumor of the breast diagnosed by core needle biopsy: a case report

Granular cell tumor rarely occurs in the breast. We report a 69-year-old woman with a right breast mass that simulated carcinoma on palpation, mammography, and ultrasonography. Aspiration biopsy cytology showed no malignant atypical cells. Core needle biopsy was performed to obtain an accurate diagnosis. The lesion was histologically confirmed to be a granular cell tumor. Immunostaining was positive for S-100 protein and vimentin, and negative for keratin, carcinoembryonic antigen, estrogen receptor and gross cystic disease fluid protein-15. The tumor was treated by wide local excision. Surgeons should be aware that granular cell tumor can resemble breast cancer in order to avoid performing a needless radical mastectomy.     

Surgeon-controlled ultrasound-guided core biopsies in the breast--a prospective study and a new use for surgeons in the clinic.

AIMS: This study was to assess the accuracy of a surgeon performing ultrasound-guided core biopsies of the breast. METHODS: A prospective audit was carried out of 555 patients who underwent an ultrasound-guided core biopsy for a discrete solid mass [under 30 mm maximum diameter] by a single surgeon. The surgeon controlled the core biopsy needle and an ultrasonographer or radiologist provided the imaging with ultrasound. RESULTS: The accuracy of the surgeon in sampling the lesions [n = 555 core biopsies] was independent of the size of the lesion. This saved 272 patients having unnecessary surgery for a benign lesion. CONCLUSION: The practical involvement by the surgeon in breast ultrasound and performing core biopsies has reduced pressure on the breast radiologists, reduced the number of diagnostic surgical open biopsies and made the clinic more interesting for the surgeon. With increased surgical confidence in breast ultrasound, most small and impalpable cancers have pre-operative skin marking rather than X-ray wire localization prior to undergoing wide local excision. Trainee breast surgeons should be encouraged to learn breast ultrasound and core biopsies.     

Biologie moléculaire des sarcomes des tissus mous

Soft tissue sarcoma includes tumours of various histological origins, with variable aggressiveness, and whose diagnosis, which determines treatment effectiveness, sometimes remains difficult to establish. Heterogeneous on the genetic level, these tumours can be classified according to our understanding of their molecular genetics: approximately 40% of sarcomas are characterized by a specific translocation or mutation. The remaining 60% have no specific modifications. In this group, approximately 20% are undifferentiated sarcomas with very simple genetics similar to differentiated lpiposarcomas, while leiomyosarcomas, pleomorphic rhabdomyosarcomas, pleomorphic liposarcomas, undifferentiated pleomorphic sarcomas, and, in particular, malignant fibrous histocytomas (MFH) are genetically very unstable, no specific rearrangement having been identified. Thanks to a number of technological advances, all of these genetic characteristics play a role in the molecular diagnosis of soft tissue sarcoma.     

Does wide excision as the initial diagnostic procedure improve prognosis in patients with cutaneous melanoma?

502 patients with clinical stage I cutaneous melanoma were reviewed to determine if performing a wide excision (4-5 cm) at the time when the diagnosis of melanoma is suspected, improves the survival. Patients were divided into two groups based on initial biopsy type and thickness category. Group 1, wide excision; group 2, total excision with narrow margins, incisional, or punch biopsies. There was no evidence that patients who had had a diagnostic and therapeutic procedure (wide excision) as the initial approach had a better survival than those who had had another form of biopsy before definitive surgery. We cannot recommend excision with wide margins as the initial biopsy procedure for a lesion suspected to be melanoma before histologic verification, since it does not increase survival for melanoma and may result in unnecessary aggressive surgery in the case of a misdiagnosed benign lesion.     

Bilateral Metachronous Paget's Disease of the Accessory Breasts in a Male

Bilateral axillary Paget''s disease in men is a rare occurrence with limited reports on its diagnosis, treatment, and prognosis. Here, we report the case of a 55-year-old Korean male, who presented with a palpable mass and eczematous skin lesion on the left axilla. An incisional biopsy and histopathologic examination indicated invasive ductal carcinoma with Paget''s disease arising in the accessory breast. Magnetic resonance imaging and positron emission tomography revealed no malignancy in the normal breast and other organs. The patient was subjected to a wide excision, wherein the left axillary lymph node was dissected, followed by the administration of adjuvant chemotherapy and radiation therapy. After 17 months of disease-free survival, the patient was diagnosed with Paget''s disease of the contralateral accessory breast. He underwent wide excision surgery along with radiation therapy. To the best of our knowledge, this is the first report of bilateral extramammary Paget''s disease in a male.     

Complementary role of adjunctive breast magnetic resonance imaging and scintimammography in patients of all ages undergoing breast cancer surgery

The aims of this study were to assess breast MRI and scintimammography (SMM) for the detection of breast cancer, and to determine any complementary role of these tests to each other and conventional imaging. Seventy‐two patients (age 35–81 years) with a suspicious breast mass were investigated by mammography, breast ultrasound, breast MRI and SMM before undergoing surgical excision of the breast mass. Sensitivity, specificity and area under receiver operator characteristic curves were calculated for each test. Of the 72 patients, there were 66 proven malignant tumours, including two patients with bilateral breast cancer. When comparing the diagnostic sensitivity of breast MRI and SMM for lesion size, both tests showed higher sensitivities for lesions >25 mm in size, particularly for SMM. When these tests were compared for patient age, patients less than 51 years showed higher sensitivities for both tests. This was statistically significant for breast MRI. The overall respective diagnostic sensitivities for mammography, mammography with breast ultrasound, breast MRI and SMM were 56, 67, 86 and 85%. The differences were significant between mammography, mammography/ultrasound and both breast MRI and SMM. Breast MRI and SMM offer incremental diagnostic advantage in the diagnosis of breast cancer. Although improved diagnostic accuracy is seen in patients of all ages, those patients less than 51 years of age receive the greatest diagnostic benefit.     

穿刺钳取活检诊断乳腺肿块

[目的]探讨一种自行设计用于定性诊断乳腺肿块的穿刺钳取活检新方法及其在应用中的优缺点和可行性。[方法]对80例患有乳腺肿块病人进行肿块取样时，在同一病人，首先使用穿刺钳取法取样活检，然后在其肿块经手术切除后，另行常规取样送检，以便将先后取材的两种样本检查结果进行对比，取得最后定性资料。[结果]在术前经穿刺钳取活检法处理的80例样本中，其病理检查结果诊断为恶性病变者4l例，良性病变者39例。而在肿块手术切除后进行常规取样送检的80例中，诊断为恶性病变者45例，良性病变者35例，其总诊断符合率为95％(76／80)。[结论]应用穿刺钳取活检法诊断乳腺肿块，技术简便、安全、准确，切实可行。