Carcinoma in situ and early breast carcinoma survey of the Portuguese Senology Society on treatment in Portugal and its evolution between 1985 and 2000

By means of a questionnaire sent to Portuguese hospitals which diagnose and treat most female patients with breast cancer, it was intended to assess the situation regarding the treatment of carcinoma in situ and early breast cancer (T1 or T2, N0 or N1), as well as their evolution between 1985 and 2000. The hospital participation rate was 65% and a sample of 865 patients was collected, distributed by the years 1985, 1990, 1995 and 2000. It was observed that, in terms of surgery, there was an increase in conservative surgery, which was over 40% in 2000, as well as an increase in the average of excised axillary lymph nodes. Progress in the surgical approach was similar both in cancer centres and in large and university hospitals, when compared with the other surveyed hospitals. Also, no differences between these two hospital groups in disease-free survival and overall survival were found. Postoperative radiotherapy was employed in more than 90% of the patients submitted to conservative surgery and adjuvant chemotherapy was used in 39% of all the patients, while tamoxifen as adjuvant treatment was used in 58% of the patients.     

Lobular carcinoma in situ of the breast. Apropos of 3 cases

The authors explain the particular nature of these multifocal tumors: absence of node involvement, difficulties of diagnosis, relatively favorable prognosis and a therapeutic dilemma: limited procedure with strict surveillance, subcutaneous bilateral mastectomy.     

Carcinoma in situ of the Fallopian tube associated with cervical carcinoma. Case report.

A case of carcinoma in situ of the fallopian tube in a 55-year-old woman, associated to cervical carcinoma is described. The necessary criteria for the diagnosis of pre-invasive carcinoma of the fallopian tube, among which the number of mitoses seems to be of great importance, are discussed. This previously unreported association of carcinoma in situ of the fallopian tube, with carcinoma of the uterine cervix, emphasizes the notion of the multicentric neoplastic possibilities of the müllerian tract derivatives.     

Lobular carcinoma in situ and invasive lobular cancer of the breast

PURPOSE OF REVIEW: The incidence of lobular carcinoma in situ and invasive lobular carcinoma of the breast is increasing. Recent data suggest that lobular carcinoma in situ is an indolent precursor for breast cancer, rather than a pure risk factor. This could imply free surgical margins become important. The risk of contralateral carcinoma and of multifocality of invasive lobular carcinoma is higher than for invasive ductal carcinoma. Therefore, the need for mastectomy, or even for preventative contralateral mastectomy is questioned. Conventional mammography or ultrasonography cannot always give useful preoperative information about the extent of lobular cancers. The value of dynamic contrast-enhanced magnetic resonance imaging needs to be established for these patients. RECENT FINDINGS: The risk of invasive carcinoma after lobular carcinoma in situ is increased. Invasive carcinoma is usually located at the index point of lobular carcinoma in situ and is of lobular histology. Dynamic contrast-enhanced magnetic resonance imaging can be useful in the detection and preoperative staging of invasive lobular carcinoma. The risk of local recurrence is high in patients with invasive lobular carcinoma. Mastectomy and breast reconstruction could be an option in selected patients. The response to preoperative chemotherapy is worse for invasive lobular carcinoma compared with invasive ductal carcinoma, with a greater need for rescue mastectomy. SUMMARY: Lobular carcinoma in situ and invasive lobular carcinoma are different entities from ductal carcinoma in situ and invasive lobular carcinoma. Their biological profile should be studied further in order to make the fine tuning of treatment possible.     

Lobular carcinoma in situ of the breast within a fibroadenoma. A case report

BACKGROUND: Fibroadenoma is a benign breast tumor that is effectively treated by local excision. Although uncommon, breast fibroadenoma may harbor breast carcinoma, either in situ or invasive. CASE: We present a 27-year-old woman who presented for the management of an apparently benign mass in the right breast. The clinician and ultrasonographic characters of the mass were indicative of a breast fibroadenoma. A local excision of the mass was performed. Histology showed the presence of LCIS within the fibroadenoma. After a detailed discussion with the patient about the available management options, the conservative approach (which includes local excision/biopsy only and regular follow-up) was preferred. CONCLUSION: LCIS within a breast fibroadenoma is a rare entity. Carcinomas arising within a fibroadenoma have the same biological behavior as those arising independently and, therefore, their management should be the same. Close surveillance following local excision/biopsy is the preferred management for LCIS within a fibroadenoma.     

Carcinoma in situ of the vagina. A study and review.

A retrospective study has been carried out on 25 patients treated at the University of Michigan Medical Center for carcinoma in situ of the vagina. Intraepithelial carcinoma of the vagina occurred as a primary entity, following treatment for preinvasive and invasive carcinoma of the cervix, and following hysterectomy for benign disease of the uterus. These patients were treated with either radium implantation or some form of surgery. Five patients had recurrences. These 5 were all subsequently retreated and are alive and without evidence of further recurrent neoplasm. This series of carcinoma in situ of the vagina is compared to other reported series. Emphasis is directed toward the need for continued use of Papanicolaou smear cytology tests in posthysterectomy patients, regardless of the reason for hysterectomy.     

Ductal carcinoma in situ of the breast with microinvasion. Role of sentinel lymph node biopsy

OBJECTIVES: To investigate the role of sentinel lymph node biopsy for microinvasive ductal carcinoma in situ of the breast. PATIENTS AND METHODS: From January 2001 to January 2006, lymphatic mapping was performed using radiocolloid and/or blue dye technique. Full axillary lymph node dissection was accomplished systematically in 10 instances at the beginning of the study, and furthermore when the sentinel node was involved (macrometastatic or micrometastatic disease). RESULTS: Identification rate was 98% (40/41), the unsuccessful procedure occurred after incisional biopsy for diagnosis. The number of sentinel nodes removed was 2 in average (1-5). Sentinel node involvement was found in 10% of cases (4/40): 1 sentinel node macrometastasis pN1, 2 sentinel node micrometastases determined by hematoxylin and eosin staining pN1 (mi), 1 sentinel node micrometastasis detected only by immunohistochemical staining pN0 (mi). DISCUSSION AND CONCLUSION: Sentinel lymph node sampling should not be currently applied for management of every ductal carcinoma in situ of the breast but a selective utilization is proposed in documented high risk subset of patients according to clinical, mammographic, and histologic features obtained by percutaneous biopsies. Ductal carcinoma in situ (DCIS) with proved or suspected microinvasion could be scheduled for sentinel node procedure a fortiori in cases undergoing mastectomy because of extensive DCIS before the occurrence of disturbances of lymphatic drainage induced by surgical breast dissection.     

Carcinoma in situ of the vagina following treatment for carcinoma of the cervix: a distinctive clinical entity.

A series of 10 patients who presented with carcinoma in situ of the vagina following treatment for carcinoma of the cervix were seen in a 3 year period and their clinical and histologic features reviewed. Vaginal lesions developed 1 to 22 years after diagnosis of carcinoma of the cervix was made. In three patients the vaginal lesions progressed to invasion. In the remaining patients repeated biopsies have revealed persistent carcinoma in situ. From this series of 10 patients we conclude that the biologic behavior of vaginal carcinoma in situ following carcinoma of the cervix resembles that of carcinoma in situ of the cervix and that carcinoma of the vagina following carcinoma of the cervix should be considered a separate clinical entity distinctive from primary invasive carcinoma of the vagina.     

Severe dysplasia and carcinoma in situ of the vagina.

Papanicolaou smears for early detection of carcinoma in situ of the cervix has been a well-recognized method of screening patients for over 30 years. The necessity for Papanicolaou smears following hysterectomy, especially for benign disease, has been a controversial subject. Twenty-two cases of carcinoma in situ of the vagina, over a period of 18 years, at the Huntington Memorial Hospital in Pasadena, California, are presented. Ninety-five percent of the lesions were first suspected by use of the Papanicolaou smears. Approximately half of previous hysterectomies were performed for benign disease. The various methods of treatment employed and the complications in these patients are discussed.     

Comparison between cytology and colposcopy in the diagnosis of early cervical carcinoma

A comparison between the results of colposcopy and of cytology shows that these methods complement each other in ideal fashion in diagnosing early stages of carcinoma of the cervix uteri. With the smear method in carcinoma in situ cases there was an error of 11.1 per cent (out of 313 cases). This may be due to the very small extent of the lesion. Colposcopy had a 3 per cent error (out of 336 cases of carcinoma in situ). By the combination of the two methods the incidence of carcinoma in situ was increased to 27.7 per cent, the Group I carcinoma to 36 to 40 per cent of all cervical carcinomas. To our knowledge, up to the present time, these figures have not been achieved by any worker with the smear method alone.     

Simultaneously occurring condylomata acuminata, carcinoma in situ and verrucous carcinoma of the vulva and carcinoma in situ of the cervix in a young woman. A case report

A case of simultaneously occurring condylomata acuminata, carcinoma in situ and verrucous carcinoma of the vulva and carcinoma in situ of the cervix was seen in a 26-year-old woman. In situ DNA hybridization on sections of the condyloma acuminata and verrucous carcinoma yielded DNA sequences for human papillomavirus 6.