Breast carcinoma post-augmentation mammaplasty: therapy with limited surgery and radiation

Due to the recent surgical and technical developments in aesthetic surgery and occasional dissatisfaction of women with their external contour, augmentation mammaplasty has become a common occurrence in the surgical practice of the aesthetic surgeon. Breast carcinomas, incidentally associated with augmentation mammaplasty, have been sporadically reported in the literature and have all been treated with a mastectomy when resection was possible. We present a case of breast carcinoma occurring 5 years after augmentation mammaplasty performed with silicone-gel-filled implants. Therapy of this carcinoma was achieved through a segmental mastectomy followed by postoperative radiation. The patient remains well 15 months postoperatively. A large number of breast implants are performed each year and the likelihood of a higher incidence of incidental breast carcinomas seen with implants is certainly possible as these patients become older; thought should be given to the notion that possibly not all of these cases need to be managed with radical surgery.     

A case of malignant fibrous histiocytoma after breast conserving therapy for breast cancer

A 45-year-old woman with malignant fibrous histiocytoma (MFH) of the breast following breast conserving therapy (BCT) is described. She noticed a lump in her left breast 52 months after BCT for breast cancer. The lump was excised and nodular fasciitis was initially diagnosed. However, the tumor recurred locally 4 times in the next 18 months. MFH was finally diagnosed. This case is considered to be radiation-induced sarcoma. The risk of radiation-induced sarcoma after BCT seems to be very low, however careful follow-up is necessary.     

A case of breast cancer detected by MRI mammography after Hollywood syndrome

A-64-year-old woman, who had been treated with augmentation mammaplasty 40 years ago, came to our hospital complaining of left breast pain. The mass was ill-defined, located in the upper outer quadrant area of her breast, and was 2 cm in diameter. MRI examination showed that the tumor had a spiculation and an irregular edge. There were no regional lymph nodes in her axilla and supra-subscapular. The diagnosis was Class IV by the fine needle aspiration biopsy cytology. We diagnosed the left breast cancer being in T2N0M0, Stage IIA, then we carried out Bt (Auchincloss method) and Sentinel lymph node biopsy (SLNB). There were metastatic cancer cells in the sentinel lymph node. So, we added level II lymph nodes dissection. The histological diagnosis was papillotubular carcinoma, f+, n+ (8/11). The endocrine receptor status of the tumor was ER+, PgR+ and the HER2/neu score was 0. There was paraffinoma in the non-cancer area. We dosed 6 cycles of FEC chemotherapy (CPA 800 mg, EPI 80 mg, 5-FU 750 mg/body x 1 cycle). We recognized no side effects of the chemotherapy for the patient.     

子宫内膜间质肉瘤保留生育功能治疗体会

Abstract  

The paper introduced the experience of a case of recurrence of endometrial stromal sarcoma with fertility conservation treatment after full-term delivery. A 24-year-old unmarried patient who, with her increasing amount of menstruation in the late six months, had a mass in her lower-abdominal which was confirmed by B-ultrasonic diagnosis as myometrium mixed mass, was given an enucleation of uterus tumor. The pathological examination of tumor sample revealed it as low-grade endometrial stromal sarcoma (LESS). And the patient underwent 6 cycles of chemotherapy over 8 months before she got pregnant and had a full-term delivery. But in 34 months after delivery, the disease recurred with metastatic of pelvic and peritoneal cavity and the patient had to receive comprehensive therapy.     

Two cases of stromal sarcoma, so-called malignant fibrous histiocytoma of breast treated with reduction surgery

CASE 1: A 64-year-old woman with right breast cancer had a partial mastectomy and radiotherapy four years ago was admitted to our hospital because of right breast mass. The vacuum associated biopsy of tumor resulted in breast sarcoma, thus a nipple-spearing mastectomy was performed. The final histological diagnosis was stromal sarcoma, and was identical to histological findings of malignant fibrous histiocytoma. Three months after the operation, a chest wall recurrence appeared. Although tumor resection with latissimus dorsi flap was performed, there were pleural dissemination and malignant pleural effusion. She died six months after the first surgery. CASE 2: A 60-year-old woman was admitted to our hospital because of left breast mass, but she refused a further clinical examination. She readmitted fourteen months later due to a huge sized left breast mass with necrosis and smelling discharge. CT scan showed a huge tumor of left breast and multiple lung metastases. Biopsy of the tumor resulted in breast sarcoma. Total mastectomy with split thickness skin grafting was performed. The final histological diagnosis was identical to the first case. A local recurrence appeared thirty days after the operation, and she died fifty-one days after the operation.     

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.     

A case of breast cancer with a chondrosarcomatous appearance

A case of a breast tumor which showed the appearance of invasive ductal carcinoma and chondrosarcoma is reported. The patient was a 36-year-old female. Simple mastectomy and lymph node dissection were performed for the tumor. Local recurrence and metastases to the contralateral breast, lymph nodes, subcutaneous tissue, and bones arose after the operation. She died of the disease 2 years and 3 months after the operation. It is thought that this tumor had formed as a result of metaplasia of the carcinomatous tissue, since a histological transition between the carcinoma and sarcoma was demonstrated.     

聚丙烯酰胺水凝胶注射式隆乳术后哺乳期感染及其处理

目的探讨聚丙烯酰胺水凝胶注射式隆乳术后哺乳期感染的最佳处理途径,拟提高该并发症处理的成功率。方法对28例聚丙烯酰胺水凝胶注射式隆乳术后哺乳期感染患者采用手术取出材料、残腔灌洗、药物连续冲洗、负压引流坏死物等综合治疗手段,彻底控制感染与炎症。结果28例患者治疗1～2周后,乳腺内感染得到控制,残腔及坏死组织全部被清除,感染炎症愈合,完整保留乳房,未有复发。结论对注射隆乳感染这类严重并发症,用手术加有效药物控制等方法正确处理,切实有效,能够保持乳房组织结构完整。     

Granulocytic sarcoma of the cervix as a primary manifestation: case without overt leukemic features for 26 months.

A case of granulocytic sarcoma involving the uterine cervix as primary manifestation without evidence of leukemia is presented. It was followed by neurological symptoms 19 months later and a right breast mass 26 months after the initial cervical lesion, but still with no evidence of leukemia. Two years and four months after onset, soft tissue and skin nodules developed and rare blastic cells appeared on peripheral blood smear. The patient terminally developed acute granulocytic leukemia with a rapidly downhill course. The differential diagnosis of granulocytic sarcoma and histiocytic lymphoma is discussed. The literature is reviewed with emphasis on the clinical and pathological problems that arise when the tumor presents in an unusual location without peripheral blood manifestation of leukemia.     

A case of breast reconstruction with a rectus abdominis musculocutaneus flap following re-lumpectomy for local recurrence of breast cancer after breast conserving therapy

A 42-year-old woman underwent breast conserving operation with irradiation for Stage I (T1 N0 M0) breast cancer at the 12 o'clock axis of her right breast. At six years after surgery, a solitary local recurrent tumor (1.2 cm in diameter) was found at the 2 o'clock axis of her right breast. No metastases were found at other sites. By the desire of the patient to conserve her breast, we performed re-lumpectomy with surgical margin (2 cm) and reconstructed with a rectus abdominis musculocutaneus flap to fill the large defect of breast tissue. One year and 5 months after surgery, the patient was doing well without recurrence, and was satisfied with the cosmetic effect.     

乳腺外科整复术在乳腺癌保乳根治术中的应用

目的:探讨乳腺外科整复术在乳腺癌保乳手术中的临床应用价值。方法:分析2010年1月至2011年6月期间应用乳腺外科整复术行保乳手术病例87例,术中根据肿瘤的大小和位置设计乳房切口。行局部扩大切除术,切缘距瘤缘的距离为1~2cm。乳房缺损部位的修复采用自身乳腺组织瓣修复法和乳腺以外的组织瓣修复法。术后1年对乳房美容效果进行客观评价和主观满意度调查。结果:年龄:29~66岁,中位年龄47岁。肿瘤大小:1~5cm,平均2.4cm。术式选择:蝙蝠翼整形11例,环乳晕整形8例,下蒂倒T整形18例,上蒂倒T整形12例,内侧整形8例,外侧整形13例,J整形2例,侧胸部带蒂脂肪筋膜组织瓣修复法9例,腹直肌鞘脂肪筋膜组织瓣修复法6例。切缘阳性率为8.0%。并发症发生率为1.6%。乳房美容效果:客观满意率为86.2%,主观满意率为88.5%。全部病例随访38~60个月,中位随访54个月,局部复发率为5.7%,5年总生存率为94.3%,5年无远处转移生存率为90.8%。结论:乳腺外科整复术术后美观效果好,患者满意度较高。     

Recurrent Primary Synovial Sarcoma of the Chest Wall

We present a case of recurrent primary synovial sarcoma of the chest wall in a 55-year-old man. Imaging at the time of recurrence revealed extensive involvement of the left pleural cavity by the tumor. The patient developed severe congestive heart failure with restrictive/constrictive physiology and subsequently died in the hospital 5 months after initial presentation. At autopsy, the tumor encased the entire left lung in a rind-like fashion and diffusely involved the pericardium. Recurrent synovial sarcoma was confirmed by histological examination. Synovial sarcoma should be considered in the differential diagnosis of chest masses, especially in young or middle-aged adults.     

Adenocarcinoma of the breast associated with silicone injections

A 42-year-old woman developed inflammatory breast cancer in a breast with "silicone mastitis" 12 years after bilateral breast augmentation with liquid silicone injections. Despite aggressive local and systemic therapy, the patient died of her disease. Breast cancer arising in silicone-injected breasts is reported infrequently, and physicians caring for patients with silicone breast injection augmentation should be aware of this potentially fatal association with breast cancer.     

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.     

Primary squamous cell carcinoma of the breast during lactation: a case report

A case of primary squamous cell carcinoma of the breast during lactation is reported. The patient was a 32-year-old woman, in post-partum lactating 18 months after delivery, who was referred to our hospital following detection of a lump in her left breast during physical examination in mass screening for breast cancer. The tumor, palpated in the upper outer quadrant of the left breast, was firm, well-defined and 2.8 x 2.6 cm in size. Ultrasonograms identified an irregular-shaped hypoechoic lesion and mammograms revealed a well-defined, circumscribed tumor. Based on these findings, breast cancer was suspected and an excisional biopsy was performed. The resected specimen was a firm, solid and circumscribed tumor with central hemorrhage. Microscopic findings demonstrated that the tumor consisted of an invasive ductal carcinoma with marked squamous metaplasia, such as keratinization and squamo-columnar junction. Breast-conserving surgery was performed and no lymph node involvement was noted. Both estrogen and progesterone receptors of the tumor were negative. Generally, the size of both squamous cell carcinoma and carcinoma during the lactation period tends to be larger than ordinary carcinomas. In this case, the cancerous lesion was detected at a relatively early stage. Although the cancerous lesion was detected at a relatively early stage and no lymph node involvement was noted, lung metastases occurred within 12 months of the surgery. Malignant potential is generally considered to be high in cases of squamous cell carcinoma of the breast with lactation and thus intensive treatment potentially resulting in severe side effects was considered to be necessary for this patient.     

Validity of local treatment including intraarterial infusion chemotherapy and radiotherapy for fungating adenocarcinoma of the breast: case report of more than 8-year survival

A 39-year-old woman came to us complaining of severe anemia (hemoglobin: 2.3 g/dl) and a painful right breast that was entirely occupied by an ulcerative, foul-smelling tumor approximately 20 cm in maximum dimension. The tumor, which was determined to be mucinous adenocarcinoma at biopsy, had invaded the chest wall with multiple lung metastases (T4cN2M1 stage IV). After a blood transfusion, the patient received the following multimodal treatment: concurrent chemoradiotherapy (50 Gy), intraarterial infusion chemotherapy consisting of doxorubicin 50 mg, mitomycin-C 10 mg, and cisplatin 50 mg, and skin graft surgery. After intraarterial infusion chemotherapy, the fungating tumor disappeared. The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission. The combination of intraarterial infusion chemotherapy and radiotherapy plays a role in successful treatment of extensive local disease of the breast.     

A case of spindle cell carcinoma of the breast, in which irinotecan was effective against respiratory failure due to pulmonary metastases

We present our experience with chemotherapy using irinotecan for lung metastases of spindle cell carcinoma of the breast. The patient is a 50-year-old female, who consulted our hospital due to a large breast tumor about 7 cm in diameter. Although computed tomography revealed invasion to the chest wall, no distant metastases were confirmed. Chemotherapy (FEC100 followed by paclitaxel) was not effective for down-staging. To improve her quality of life, standard radical mastectomy with combined partial resection of the chest wall was performed. The tumor was histologically diagnosed as spindle cell carcinoma. After the operation, multiple lung metastases appeared, and she had severe dyspnea. Thereafter irinotecan was administered. One week after the administration, metastatic lesions were reduced so that her dyspnea was remarkably relieved. The patient continued to receive irinotecan weekly until she died on the 49th day of treatment with irinotecan.     

A Rare Case of Asynchronous Bilateral B-cell Lymphoma of the Breast

We report an asynchronous bilateral malignant lymphoma of thebreast, in a 56-year-old woman, presenting unusual clinicalsigns and histological features. The patient, who had a familyhistory of breast cancer, had undergone a standard right radicalmastectomy four years previously for a non-epithelial malignanttumor. At that time, the tumor was thought to be a stromal sarcoma,because some of the neoplastic cells were elongated or vacuolated.The patient recently became aware of a rapidly growing tumorof the left nipple without erosion or pain. This tumor underwentbiopsy, and the histological examination showed a non-Hodgkin'slymphoma of diffuse mixed type. Staging procedures demonstratedno sign of generalized disease. Following a modified left radicalmastectomy for optimal local control and accurate staging, adjuvantchemotherapy consisting of vincristine, cyclophosphamide, prednisoloneand doxorubicin was initiated. Immunohistochemical stainingfor PAN-B and leucocyte common antigen revealed both tumorsto be malignant lymphomas of B-cell type, and the first lymphomaof the right breast was thought to be showing ‘signetring’ cell change. Since the two tumors were morphologicallyquite different from each other, h was suggested that they wereasynchronous bilateral primary malignant lymphomas; however,the possibility remains that the recent left breast tumor isa recurrence of the malignant lymphoma of the right breast.The patient is currently disease-free, 10 months after surgery     

Undifferentiated Pleomorphic Sarcoma of the Male Breast Causing Diagnostic Challenges

Undifferentiated pleomorphic sarcoma of the breast are uncommon and often present diagnostic challenges. Herein, we report a case of the undifferentiated pleomorphic sarcoma occurring in the male breast. A 76-year-old man presented with a palpable bean-sized mass in his left breast for two months. Core needle biopsy revealed the presence of atypical cells in a fibrous proliferative lesion, which was removed by wide excision. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle cell lesion with uncertain malignant potential. One year later, the patient returned with a recurrent mass atthe previous surgical site. The mass was again surgically removed using wide excision. Based on histological findings with immunomarkers, the final diagnosis was undifferentiated pleomorphic sarcoma. Undifferentiated pleomorphic sarcoma of the breast can cause genuine diagnostic difficulty and appropriate immunohistochemistry is mandatory for differential diagnosis.     

Interventricular methotrexate therapy for carcinomatous meningitis due to breast cancer: a case with leukoencephalopathy

A 46-year-old woman presented with paraplegia and severe lumbago. She had had a radical mastectomy for left breast cancer 10 years earlier, and 6 months prior to presentation she completed CMF chemotherapy for treatment of retroperitoneal metastasis. CT and MRI to identify potential causes of the paraplegia and lumbago showed leptomeningeal carcinomatosis due to dissemination from invasive recurrence of the retroperitoneal tumor. An Ommaya reservoir was inserted, and infusion of intrathecal methotrexate (MTX; 5 mg twice weekly) began. Her clinical symptoms improved after receiving 53 mg MTX. However, after receiving 83 mg MTX, the patient became dizzy from leukoencephalopathy. Although administration of prednisolone mostly resolved her symptom, the patient died 9 months after the diagnosis of carcinomatous meningitis.