Breast Disease - Volume 39, issue 2

Authors: Febres-Aldana, Christopher A. | Kuritzky, Nicolas | Krishnamurthy, Kritika | Poppiti, Robert | Howard, Lydia

Article Type: Research Article

Abstract: BACKGROUND: Hormone-receptor-negative breast carcinoma (HRNBC), including triple-negative and HER-2 amplified tumors, can overexpress P16INK4a with substantial contribution to tumor progression. In nonneoplastic cells, P16INK4a mediates growth arrest and senescence secondary to cytotoxic compounds. OBJECTIVE: We assessed the impact of neoadjuvant chemotherapy (NAC) on P16INK4a expression in breast specimens. METHODS: P16INK4a and CD-44 were evaluated by immunohistochemistry in biopsies and subsequent post-NAC excision in a cohort of 27 women with HRNBC. Positivity was estimated on hotspots of tissue available by calculating cellular densities in nonneoplastic tissues with a low proliferation rate (Ki-67 …< 1%) and tumor percentage using ImageJ 1.51t (National Institutes of Health, USA). RESULTS: Pre-NAC P16INK4a and CD-44 tumor expression were similar between the complete (n = 15) and incomplete (n = 12) response groups. Residual HRNBCs exhibited decreased immunoreactivity for P16INK4a , while the expression of CD-44 increased (n = 10, P < 0.05). The magnitude of change correlated with the baseline expression (r = 0.37, P16; r = −0.85, CD-44). Post-NAC nonneoplastic mammary duct and lobular epithelia, perilobular stroma, and adipose tissue, but not peritumoral stroma, accumulated P16INK4a (+) cells. The post-NAC cellular density change was more significant in epithelia of patients with high P16INK4a (+) baseline (r = 0.86, P < 0.0001) and those with a complete pathologic response (n = 14, P < 0.05). All tumors beds with complete treatment effect showed diffuse P16INK4a positivity. CONCLUSION: NAC induced the accumulation of P16INK4a (+)cells in nonneoplastic breast tissues more pronounced in patients with a complete pathologic response. Therapy-induced senescence is a potential marker of bystander damage due to NAC. P16INK4a loss and CD-44 gain may represent a phenotype of chemoresistance in residual HRNBCs. Show more

Keywords: Breast cancer, chemotherapy, P16INK4a, CD-44, therapy-induced senescence

DOI: 10.3233/BD-190419

Citation: Breast Disease, vol. 39, no. 2, pp. 51-59, 2020

Authors: Pujani, Mukta | Jain, Harsh | Chauhan, Varsha | Agarwal, Charu | Singh, Kanika | Singh, Mitasha

Article Type: Research Article

Abstract: Background: Tumour infiltrating lymphocytes (TILs) exhibit the local immune response directed against tumor growth and metastasis. TILs have emerged as a tool to assess immune-reactivity in various malignancies including colon, ovary, lung, bladder, breast etc as well as independent marker of favourable prognosis in many tumors. TILs in breast cancer (BC) play a role in tumor response to therapy in the adjuvant and neoadjuvant settings, especially in triple-negative cancers. Material & Methods: This cross sectional study comprised of 101cases of invasive breast carcinoma. For each case, a representative 5 μm H&E stained section was selected and the clinicopathological details …were recorded. To establish the molecular subtype of breast cancer, immunohistochemistry for ER, PR and Her2neu was done. Both stromal (sTIL) and intratumoral (iTIL) TILs were assessed based on the recommendations of the International TIL Working Group (ITILWG). Results: A statistically significant difference was observed in the mean sTIL as well as iTIL scores and tumor grade, size, molecular type and lymph node metastasis. A signification correlation was observed between stromal TIL and tumor grade, lymph node metastasis, molecular subtype and mitosis. Intratumoral TIL showed a significant correlation with tumor size, mitosis, tumor grade, distant metastasis, stage and lymph node metastasis. Moreover, stromal and intratumoral TIL showed a highly significant correlation with each other. Conclusion: The ITILWG recommendations are reproducible and reliable for the evaluation of sTILs and iTILs. TILs, as evaluated on Hematoxylin and eosin (H&E) slides, has been shown in numerous studies now to be a reliable, reproducible, inexpensive and readily available marker of pre-existing antitumor immunity in breast cancer. We suggest that TILs should be evaluated for each case of breast carcinoma and should be part of histopathology report. Show more

Keywords: Breast cancer, tumor infiltrating lymphocytes, stromal TIL, intratumoral TIL

DOI: 10.3233/BD-200442

Citation: Breast Disease, vol. 39, no. 2, pp. 61-69, 2020

Authors: Kim, Suk Jung | Park, Young Mi

Article Type: Research Article

Abstract: BACKGROUND: With an aging society, Korean women ≥70 years of age are increasingly being diagnosed with breast cancer. OBJECTIVE: To investigate the clinicopathological and biological characteristics of breast cancer in elderly Korean women and compare them with breast cancer in elderly (≥70 years) women globally and in Korean women of all ages. METHODS: We retrospectively reviewed the clinicopathological and biological features of breast cancer in elderly Korean women (≥70 years; n = 87) who sought treatment during 2004–2014 from a single institution. These data were indirectly compared with data of Korean women of all ages (nationwide …Korean Breast Cancer Registry) or elderly women globally (meta-analysis). RESULTS: Compared to elderly women with breast cancer globally, Korean elderly women had a more symptomatic presentation, lower ER expression, and overexpression or amplification of human epidermal growth factor receptor 2. Compared to Korean women of all ages with breast cancer, elderly Korean women presented with advanced tumor stages, larger tumor size, more lymph node involvement, and more luminal B and basal-like subtypes. CONCLUSIONS: Breast cancer had a more aggressive clinicopathological and biological characteristics in elderly Korean women than in Korean women of all ages or elderly women globally. Show more

Keywords: Asia, breast cancer subtype, elderly Korean

DOI: 10.3233/BD-190422

Citation: Breast Disease, vol. 39, no. 2, pp. 71-83, 2020

Authors: Brachtenbach, Travis | Cardenas, Raquel | Pate, Heather | Solis, Luanne | Chinnery, Lauren | Bowers, Aaron | Vassar, Matt

Article Type: Research Article

Abstract: Introduction: Breast cancer is the most common cancer in women, affecting approximately 1 in 8 women worldwide. Additionally, it is either the most or second-most lethal cancer depending on ethnicity. Many women and concerned family members turn to the internet for information regarding the signs, symptoms, diagnosis and treatment of this life-altering condition. We sought to objectively evaluate the quality of the information available on YouTube concerning breast cancer. Methods: We searched YouTube for videos relating to breast cancer. We included videos that were less than 20 minutes in length, were in the top 200 for most views …and were available in English, either subtitled or narrated. Videos were independently and blindly scored using a standardized scoring form. Possible scores ranged from negative infinity to 25.5 with one point being deducted for each misleading statement or claim. Results: After exclusions, 133 videos in our sample were evaluated. Out of a possible 25.5 points, the true mean was 3.90 with a standard deviation of 1.38. There were only 30 videos (22.5%) that scored more than 7 points. 12 (9.0%) videos scored 0 points or fewer. 12 (9.0%) of the videos in our sample contained at least one misleading statement with 9 of those contained multiple misleading statements with some videos having up to 10 such statements. Conclusion: While YouTube is an important source of information regarding breast cancer, few videos contain a significant amount of quality information and many of the videos contain false or misleading statements. In an area where patients are often scared and searching for answers, there is a significant need for more high-quality videos to educate patients and dispel myths and pseudoscience. Show more

Keywords: YouTube, media, patient education, breast cancer, evidence-based medicine

DOI: 10.3233/BD-200445

Citation: Breast Disease, vol. 39, no. 2, pp. 85-90, 2020

Authors: Suhani, S. | Kazi, Mufaddal | Parshad, Rajinder | Seenu, Vathulru | Verma, Eshan | Mathur, Sandeep | Gupta, Siddharth D. | Haresh, K.P.

Article Type: Research Article

Abstract: Background: Breast cancer is the commonest cancer among women. India along with United States and China collectively account for one third of the global burden. The present study reports the clinico-epidemiological data of our patient population. This may help in better understanding of the disease in our population and also form ground for conducting further breast cancer research in India. Methods: The study was conducted at an apex teaching and medical research institution in India from September 2013 to April 2015 as a retrospective review of prospectively collected data of breast cancer patients. The socio-demographic characteristics, reproductive risk …factors, clinical presentation, TNM staging and histopathological characteristics for breast cancer in these patients were recorded. The data was recorded on an Xcel spreadsheet and analyzed using IBM SPSS 21. Results: The study comprised of 1310 breast cancer patients with males comprising 1.1%. The median age of presentation was 47 years, and menarche 14 years. Most of women were married and multiparous. More than half of the women were postmenopausal at presentation. All patients were symptomatic at presentation with median duration of symptom of 5 months and median lump size of 5 cm. Most common stage at presentation was Stage II and most common histopathology was Invasive ductal carcinoma. 61.9% tumors were hormone receptor positive. Triple negative cancers formed one third of all tumors. Conclusion: Breast cancer in the Indian scenario is a disease of younger woman who lack the characteristic reproductive and demographic risk factors. This calls for a need to study the clinico-demographic risk factors and characteristics of our own population. Show more

Keywords: Breast cancer, audit, epidemiology

DOI: 10.3233/BD-190435

Citation: Breast Disease, vol. 39, no. 2, pp. 91-99, 2020

Authors: Upadhyaya, Siddhi N. | Fan, Betty | Bernard, Steven L. | Samaras, Christy J. | Valente, Stephanie A.

Article Type: Case Report

Abstract: We present a case of surgical removal of primary amyloidosis of the breast utilizing an oncoplastic reduction pattern technique. Primary amyloidosis of the breast is a very rare benign disease characterized by accumulation of insoluble amyloid protein. Biopsy is required for definitive diagnosis, and surgical removal of the mass with clear margins is the main treatment for primary amyloidosis. Oncoplastic reduction pattern technique allows for removal of large breast lesions and correction of the resulting defect by combining the extirpative principles of surgical oncology with the aesthetic principles of breast reduction surgery.

Keywords: Amyloidosis, breast mass, oncoplastic

DOI: 10.3233/BD-190424

Citation: Breast Disease, vol. 39, no. 2, pp. 101-104, 2020

Authors: Singh, Prashant Kumar | Rehman, Faizul | Rathod, Vivek | Sinha, Laxmi | Jha, Chandan Kumar

Article Type: Case Report

Abstract: Intracystic papillary carcinoma (IPC) is a rare malignancy of the breast which is usually found in postmenopausal women. It is still rarer in males and may present with signs of a benign cystic lump. It is sub-classified into three equally prevalent groups considering treatment strategies: intracystic papillary carcinoma alone, intracystic papillary carcinoma with ductal carcinoma in-situ , and those with evidence of invasion. Even if a preoperative diagnosis is achieved, there are no specific guidelines for the treatment of IPC. Treatment modalities including the extent of surgical excision, lymph node dissection, radiation, and chemotherapy are determined by the grade and …size of the lesion and sub-types. However, several reports and studies showed good prognosis with conservative surgery without axillary dissection in IPC not associated with carcinoma in situ or micro-invasion. We present a 40 years old male patient with IPC who was managed by modified radical mastectomy and adjuvant hormone therapy. A brief review of the literature and clinical characteristics, pathology, and treatment of IPC are discussed. Show more

Keywords: Intracystic papillary carcinoma, male breast carcinoma, rare breast malignancies

DOI: 10.3233/BD-190421

Citation: Breast Disease, vol. 39, no. 2, pp. 105-107, 2020

Authors: da Costa Vieira, René Aloisio | de Araujo Silva, Igor | de Souza Coelho, Rafael Darahem | de Almeida Junior, Carlos Roberto | de Almeida Santos Yamashita, Mauricio Eiji

Article Type: Case Report

Abstract: BACKGROUND: Schwannoma is an extremely rare benign tumour of the peripheral nervous system; its association with breast cancer is sporadic, and its association with the brachial plexus is extremely rare. CASE DESCRIPTION: The authors report a case of a patient with breast cancer associated with nodulation in the left supraclavicular fossa, and due to the clinical and radiological features, it was considered metastatic lymph node disease. The patient underwent neoadjuvant chemotherapy, with partial response of the breast. Surgical treatment included resection of the supraclavicular nodule, which was found to be a supraclavicular fossa schwannoma. The correct diagnosis, influences …the radiotherapeutic planning. The unusual presentation led to diagnostic confusion in the present case, a fact that changed the breast treatment. CONCLUSION: The best of our knowledge it is the third description of brachial plexus schwannoma associated with breast cancer and the first with a synchronous association. The knowledge of this pathology and its potential to alter treatment justify the reporting of the present case. Show more

Keywords: Breast neoplasms, neurilemmoma, scwannoma, brachial plexus, diagnosis, differential

DOI: 10.3233/BD-190432

Citation: Breast Disease, vol. 39, no. 2, pp. 109-113, 2020

Authors: Al-Balas, Mahmoud | Alwiswasy, Mohammad | Al-Balas, Hamzeh | Serra, Margherita | Aleshawi, Abdelwahab

Article Type: Case Report

Abstract: Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast condition commonly presented as an incidental microscopic finding. However, it can also manifest as a mass-forming lesion (tumorous PASH) or as gigantomastia (diffuse PASH). Most of the previously reported cases are unilateral tumorous PASH treated by mastectomy. In this article, we reported a rare case of diffuse bilateral PASH. A 21-year-old woman presented with a two-year history of bilateral breast enlargement and neck pain. Physical examination revealed asymmetrical bilateral macromastia with profound ptosis. Breast ultrasound demonstrated no cysts or masses in both breasts. The decision was made to perform an inverted T …bilateral reductive mammoplasty which was performed successfully through a superior-central pedicle approach. Microscopic examination of the specimens confirmed the diagnosis of PASH without any evidence for malignancy. Nine months postoperatively, the size for both breasts was optimal the patient was satisfied. Recognition and reporting of this rare form of PASH is essential for proper investigation, pathology understanding, risk factors recognition, prognosis assessment and treatment methods selection. Show more

Keywords: Breast, Gigantomastia, Reductive mammoplasty, Pseudoangiomatous stromal hyperplasia

DOI: 10.3233/BD-190428

Citation: Breast Disease, vol. 39, no. 2, pp. 115-118, 2020