scholarly journals Metastasis of neuroendocrine tumor mimicking primary breast cancer: case report

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Yuki Tany Hirakawa Vieira ◽  
Andre Luiz de Freitas Perina ◽  
Daniela Ferreira Vieira Vendramini ◽  
Thatyanne Cunha Esposito Gallo ◽  
Felipe Eduardo Martins Andrade
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neuroendocrine Tumor ◽  
Axillary Lymph Node ◽  
Cervical Lymph Node ◽  
Ileocecal Valve ◽  
Axillary Lymph ◽  
Regional Lymph Nodes ◽  
The Right

Introduction: Neuroendocrine tumor has an annual incidence of 2–5 cases/100,000 inhabitants, most of them asymptomatic, and may clinically present as carcinoid syndrome: facial flushing, diarrhea, and bronchospasm. It has a great tendency to metastasize to regional lymph nodes and liver, being unusual in the breast. Clinical case: A black 47-year-old woman without comorbidities presented a nodule with progressive growth for 2 years in the right upper inner quadrant (RUIQ), biopsied and diagnosed as breast cancer, without a specific subtype or immunohistochemistry (IHC). Physical examination revealed a 3 cm nodule, hard and fixed axillary lymph node, and enlarged yet fibroelastic and mobile anterior cervical lymph node. Ultrasound (US) identified two irregular nodules in the RUIQ and the junction of the right outer quadrants (JROQ) measuring 2.5 cm and 0.7 cm, respectively, and level I axillary lymph node with cortical thickening. The JROQ nodule and the axillary lymph node were biopsied. The cervical lymph node did not show loss of hilum or suspicious abnormalities on US and was not biopsied. Anatomopathological results of the nodule were compatible with invasive carcinoma without a specific subtype, with estrogen receptor weakly positive (10%), Ki-67 7%, and negative for other markers. The axillary lymph node was negative for metastasis. During staging, an abdominal computed tomography identified a 1.9 cm lesion of likely neuroendocrine origin in the ileocecal valve with metastasis to the liver, regional lymph nodes, and breast. Complementary IHC of the biopsy slide was later performed with chromogranin, synaptophysin, and CDX-2, and the diagnosis reached was breast metastasis of neuroendocrine tumor. An external review of biopsy slides of the RUIQ nodule was requested, and the patient was referred to the oncology department to continue treatment. Conclusion: Metastasis of gastrointestinal tumors to the breast corresponds to less than 0.5% of cancers, with 15 reports in the literature, of which only 7 were asymptomatic, and their clinical presentation started with breast lesion, as in the case described herein. Given its rarity, as well as the clinical and radiological difficulties in differentiating these lesions, special attention must be paid to differential diagnoses, especially in cases of discrepancies between the tumor histology and IHC or lack of correlation between image and clinical condition.

scholarly journals Dedicated Axillary MRI-Based Radiomics Analysis for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 757
Author(s):  
Sanaz Samiei ◽  
Renée W. Y. Granzier ◽  
Abdalla Ibrahim ◽  
Sergey Primakov ◽  
Marc B. I. Lobbes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Mr Images ◽  
Node Metastasis

Radiomics features may contribute to increased diagnostic performance of MRI in the prediction of axillary lymph node metastasis. The objective of the study was to predict preoperative axillary lymph node metastasis in breast cancer using clinical models and radiomics models based on T2-weighted (T2W) dedicated axillary MRI features with node-by-node analysis. From August 2012 until October 2014, all women who had undergone dedicated axillary 3.0T T2W MRI, followed by axillary surgery, were retrospectively identified, and available clinical data were collected. All axillary lymph nodes were manually delineated on the T2W MR images, and quantitative radiomics features were extracted from the delineated regions. Data were partitioned patient-wise to train 100 models using different splits for the training and validation cohorts to account for multiple lymph nodes per patient and class imbalance. Features were selected in the training cohorts using recursive feature elimination with repeated 5-fold cross-validation, followed by the development of random forest models. The performance of the models was assessed using the area under the curve (AUC). A total of 75 women (median age, 61 years; interquartile range, 51–68 years) with 511 axillary lymph nodes were included. On final pathology, 36 (7%) of the lymph nodes had metastasis. A total of 105 original radiomics features were extracted from the T2W MR images. Each cohort split resulted in a different number of lymph nodes in the training cohorts and a different set of selected features. Performance of the 100 clinical and radiomics models showed a wide range of AUC values between 0.41–0.74 and 0.48–0.89 in the training cohorts, respectively, and between 0.30–0.98 and 0.37–0.99 in the validation cohorts, respectively. With these results, it was not possible to obtain a final prediction model. Clinical characteristics and dedicated axillary MRI-based radiomics with node-by-node analysis did not contribute to the prediction of axillary lymph node metastasis in breast cancer based on data where variations in acquisition and reconstruction parameters were not addressed.

scholarly journals Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Xiaokai Ma ◽  
Shishuai Wen ◽  
Baofeng Liu ◽  
Dumin Li ◽  
Xiaolong Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Upper Extremity ◽  
Axillary Lymph Node ◽  
Lymphatic Drainage ◽  
Sentinel Lymph Nodes ◽  
Blue Dye ◽  
Axillary Lymph ◽  
Axillary Reverse Mapping

Purpose. The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients.Methods. Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping.Results. ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs.Conclusions. The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema.Clinical Trial Registration. This trial is registered with ClinicalTrial.gov:NCT02651142.

Possibility to Use the Radiopharmaceutical Based on the Gamma-Aluminum Oxide Labeled with 99mTc to Identify Sentinel Lymph Nodes in the Experiment

2015 ◽  
Vol 1084 ◽  
pp. 443-446 ◽  
Author(s):  
Vladimir Chernov ◽  
Anna Titskaya ◽  
Ivan Sinilkin ◽  
Roman Zelchan ◽  
Natalya V. Varlamova
Keyword(s):  
Experimental Study ◽  
Lymph Node ◽  
Aluminum Oxide ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Subcutaneous Injection ◽  
Sentinel Lymph Nodes ◽  
Male Rats ◽  
Axillary Lymph ◽  
The Right

Studying the possibility of using the radiopharmaceutical to identify sentinel lymph nodes were carried out on male rats. The preparation was injected subcutaneously in the I interfinger space of the right forelimb. Radiometry of rats’ organs showed that the studied preparation was actively accumulated in the axillary lymph node after subcutaneous injection. The experimental study of the pharmacokinetics of radiopharmaceutical based on gamma-oxide aluminum labeled with 99mTc showed that the analyzed RPP can be successfully used for lymphoscintigraphy and visualization of sentinel node starting with the 15th minute and up to the 24th hour after subcutaneous injection.

The prognostic value of nodal ratios in node-positive breast cancer: AUBMC experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21072-21072
Author(s):  
A. Shamseddine ◽  
H. Hatoum ◽  
Z. Salem ◽  
Z. Abdel Khalek ◽  
N. El Saghir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Disease Free Survival ◽  
Axillary Lymph ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

21072 Background: Axillary lymph node metastasis has proven to be the most important factor affecting overall survival (OS) and disease free survival (DFS) in patients with breast cancer. Recent evidence suggests that axillary lymph node ratio (LNR) may be at least as important as absolute number of involved lymph nodes in predicting OS and DFS. The aim of this retrospective study is to evaluate the impact of axillary nodal ratios in node-positive breast cancer as a prognostic factor for survival. Methods: Data from 1181 patients with stage I, II and III breast cancer diagnosed at AUBMC between 1990 and 2001 were studied. The median age at diagnosis was 50 years (23 - 88); the median number of lymph nodes dissected was 17 (0 - 49). Survival was compared in 737 patients with node-positive disease according to a LNR below or more than 0.25 (defined as number of involved lymph nodes divided by total dissected axillary lymph nodes). Results: Patients with LNR = 0.25 had a median follow-up of 30 months (1.2–156) and a median DFS of 26 months (1–156). The 5-year survival was 26.2% (94/358) and the 5-year DFS was 22.9% (82/358). Patients with LNR <0.25 had a median follow-up of 36 months (1.2–157) and a median DFS of 36 months (1–157). The 5-year survival of 33.2% (245/737) and the 5-year DFS was 29.8 % (220/737). LNR showed significance as a continuous variable and a categorical variable (0, < 0.25, and = 0.25) with a p < 0.001 Conclusions: LNR significantly predicts OS and DFS in node-positive primary breast cancer. No significant financial relationships to disclose.

scholarly journals Omitting radiotherapy is safe in breast cancer patients ≥ 70 years old after breast-conserving surgery without axillary lymph node operation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ying Zhong ◽  
Yali Xu ◽  
Yidong Zhou ◽  
Feng Mao ◽  
Yan Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Breast Conserving Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Metastasis Rate

Abstract To verify whether omitting radiotherapy from breast cancer treatment for patients ≥ 70 years old following breast-conserving surgery (BCS) without axillary lymph node dissection is safe. Previous studies have shown that omitting breast radiotherapy after BCS and axillary lymph node dissection is safe for elderly breast cancer patients. We aimed to evaluate the safety of BCS without axillary surgery or breast radiotherapy (BCSNR) in elderly patients with breast cancer and clinically negative axillary lymph nodes. We performed a retrospective analysis of 481 patients with breast cancer, aged ≥ 70 years, between 2010 and 2016. Of these, 302 patients underwent BCSNR and 179 underwent other, larger scope operations. Local recurrence rate, ipsilateral breast tumor recurrence (IBTR) rate, distant metastasis rate, breast-related death, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. After a median follow-up of 60 months, no significant differences in local recurrence, distant metastasis rate, breast-related death, and DFS were noted. The OS was similar (P = 0.56) between the BCSNR group (91.7%) and other operations group (93.0%). The IBTR rate was considered low in both groups, however resulted greater (P = 0.005) in the BCSNR group (5.3%) than in other operations group (1.6%). BCSNR did not affect the survival of elderly patients with breast cancer with clinically negative axillary lymph nodes. IBTR was infrequent in both groups; however, there was a significant difference between the two groups. BCSNR is a feasible treatment modality for patients with breast cancer ≥ 70 years old with clinically negative axillary lymph nodes.

Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20106-20106
Author(s):  
R. K. Shahid ◽  
I. Ahmad ◽  
S. Yadav ◽  
A. Sami ◽  
K. Haider ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Axillary Lymph Node ◽  
Primary Breast Cancer ◽  
Fish Analysis ◽  
Axillary Lymph ◽  
Her 2

20106 Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER. No significant financial relationships to disclose.

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