scholarly journals Inflammatory Myofibroblastic Tumor of the Breast: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 305
Author(s):  
Ahmet Salih Karaoglu ◽  
Mahmut Hudai Demir ◽  
Abdullah Ayaz ◽  
Hamza Uysal ◽  
Tuce Soylemez ◽  
...  
Keyword(s):  
Lymph Node ◽  
Tumor Cells ◽  
Smooth Muscle Actin ◽  
Inflammatory Cells ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Chromosome Band ◽  
Anaplastic Lymphoma ◽  
Palpable Lump ◽  
Intramammary Lymph Node

Inflammatory myofibroblastic tumors (IMTs) of the breast are extremely uncommon lesions, usually labelled as a subgroup of inflammatory pseudotumors. They are composed of inflammatory cells and bland spindle cells without nuclear atypia. Nearly half of all IMTs of the breast include clonal translocation of the anaplastic lymphoma kinase (ALK) gene, located at the chromosome band 2p23, and generally present with a palpable lump, swelling, and pain. Herein, we present a 66-year-old female patient with pain, swelling and a palpable lump in her right breast. A 40×26 mm sized T1A hypointense and T2A hyperintense mass with slightly lobulated margins was detected at breast magnetic resonance imaging. A mass associated with an intramammary lymph node was evaluated in the upper inner quadrant of the right breast via mammography. The results were considered as BI-RADS 3. Breast-conserving surgery with sentinel lymph node biopsy was performed. During pathological evaluation, cytoplasm with poorly-defined margins, and large-nucleoli tumor cells with benign ducts between these tumor cells, were observed. Intensive inflammatory cell infiltration and sclerotic changes in different areas were also noted. The lesion stained positive for caldesmon, smooth muscle actin, vimentin, CD10, and S100; however, it was negative for ALK on immunohistochemistry. The patient remained disease-free after the surgical procedure.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 305-308

scholarly journals Successful Alectinib Treatment for Carcinoma of Unknown Primary with EML4-ALK Fusion Gene: A Case Report

2021 ◽  
Vol 28 (3) ◽  
pp. 1938-1945
Author(s):  
Keiji Sugiyama ◽  
Ai Izumika ◽  
Akari Iwakoshi ◽  
Riko Nishibori ◽  
Mariko Sato ◽  
...  
Keyword(s):  
Lymph Node ◽  
Cervical Lymph Node ◽  
Kinase Inhibitors ◽  
Fusion Gene ◽  
Liver Lesion ◽  
Lymph Node Biopsy ◽  
Unknown Primary ◽  
Carcinoma Of Unknown Primary ◽  
Anaplastic Lymphoma ◽  
Lymph Node Swelling

Gene alteration in anaplastic lymphoma kinase (ALK) is rare, and the efficacy of ALK inhibitors in the treatment of carcinoma of unknown primary (CUP) with ALK alteration remains unclear. The patient was a 56-year-old woman who presented with cervical lymph node swelling. Computed tomography revealed paraaortic, perigastric, and cervical lymph node swelling; ascites; a liver lesion; and a left adrenal mass. A cervical lymph node biopsy was performed, and pathological diagnosis of an undifferentiated malignant tumor was conducted. Finally, the patient was diagnosed with CUP and treated with chemotherapy. To evaluate actionable mutations, we performed a multigene analysis, using a next-generation sequencer (FoundationOne® CDx). It revealed that the tumor harbored an echinoderm microtubule-associated protein-like 4 (EML4) and ALK fusion gene. Additionally, immunohistochemistry confirmed ALK protein expression. Alectinib, a potent ALK inhibitor, was recommended for the patient at a molecular oncology conference at our institution. Accordingly, alectinib (600 mg/day) was administered, and the multiple lesions and symptoms rapidly diminished without apparent toxicity. The administration of alectinib continued for a period of 10 months without disease progression. Thus, ALK-tyrosine kinase inhibitors should be considered in patients with CUP harboring the EML4-ALK fusion gene.

scholarly journals Is It Contralateral Axillary Metastasis or Occult Breast Cancer: A Confusing Case Report

2015 ◽  
Vol 8 (3) ◽  
pp. 498-502 ◽  
Author(s):  
Yong Gi Son ◽  
Woon Won Kim ◽  
Ki Hoon Kim ◽  
Jin Soo Kim
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Growth Factor Receptor ◽  
Immunohistochemical Analysis ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Lymph Node Biopsy ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Axillary Metastasis

We report the case of a 43-year-old woman with primary left breast cancer presenting metastatic lymphadenopathy in the contralateral axilla. This patient represents a diagnostic and therapeutic challenge because primary breast cancer, occult contralateral breast cancer, and extra-mammary primary lesion can all be the source of the contralateral axillary metastasis. Left breast-conserving surgery, left sentinel lymph node biopsy, right breast mass excision, and right axillary lymph node dissection were performed. Immunohistochemical analysis revealed that the left breast cancer specimen was positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for human epidermal growth factor receptor 2 (HER2). In contrast, the right axillary lymphadenopathy specimen was negative for ER and PR, but positive for HER2. Further investigation revealed no evidence of occult primary cancers or extra-mammary tumors. After surgical intervention, the patient was treated with adjuvant chemotherapy, adjuvant radiation therapy, and targeted therapy with trastuzumab. Two years after diagnosis, she is free of disease and presently being treated with tamoxifen.

scholarly journals Efficacy of Pectoral Nerve Block Type II for Breast-Conserving Surgery and Sentinel Lymph Node Biopsy: A Prospective Randomized Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Doo-Hwan Kim ◽  
Sooyoung Kim ◽  
Chan Sik Kim ◽  
Sukyung Lee ◽  
In-Gyu Lee ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Control Group ◽  
Block Type ◽  
Type Ii ◽  
Node Biopsy ◽  
Pectoral Nerve

Objectives. The pectoral nerve block type II (PECS II block) is widely used for postoperative analgesia after breast surgery. This study evaluated the analgesic efficacy of PECS II block in patients undergoing breast-conserving surgery (BCS) and sentinel lymph node biopsy (SNB). Methods. Patients were randomized to the control group (n=40) and the PECS II group (n=40). An ultrasound-guided PECS II block was performed after induction of anesthesia. The primary outcome measure was opioid consumption, and the secondary outcome was pain at the breast and axillary measured using the Numerical Rating Scale (NRS) 24 hours after surgery. Opioid requirement was assessed according to tumor location. Results. Opioid requirement was lower in the PECS II than in the control group (43.8 ± 28.5 µg versus 77.0 ± 41.9 µg, p<0.001). However, the frequency of rescue analgesics did not differ between these groups. Opioid consumption in the PECS II group was significantly lower in patients with tumors in the outer area than that in patients with tumors in the inner area (32.5 ± 23.0 µg versus 58.0 ± 29.3 µg, p=0.007). The axillary NRS was consistently lower through 24 hr in the PECS II group. Conclusion. Although the PECS II block seemed to reduce pain intensity and opioid requirements for 24 h after BCS and SNB, these reductions may not be clinically significant. This trial is registered with Clinical Research Information Service KCT0002509.

Indication of sentinel lymph node biopsy with breast-conserving surgery for ductal carcinoma in situ considering lymphatic flow.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 192-192
Author(s):  
Ayane Yamaguchi ◽  
Shigeru Tsuyuki ◽  
Miru Okamura ◽  
Yukiko Kawata ◽  
Kosuke Kawaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Outer Quadrant ◽  
Lymphatic Flow ◽  
Node Biopsy

192 Background: Ductal carcinoma in situ (DCIS) has been regarded as curable with resection, but axillary lymph node metastases have been reported in 2% of DCIS patients. Even when DCIS has been diagnosed by preoperative core needle biopsy (CNB), 8% to 38% of the patients have been found to have invasive ductal carcinoma (IDC) on the basis of pathological diagnosis after surgical treatment. The indication of sentinel lymph node biopsy (SLNB) and breast-conserving surgery (BCS) for DCIS is still controversial. Methods: SLNB is a standard surgical technique for early breast cancer treatment, and indocyanine green (ICG) fluorescence method is remarkable in terms of the visualization of lymphatic flow. We analyzed the variation in lymphatic drainage routes from the nipple to the SLN (sentinel lymphatic routes) by using the ICG florescence method in early breast cancer patients and investigated the effects on the localization of the tumor to the sentinel lymphatic routes after BCS. Results: From November 2010 to April 2012, we recorded the sentinel lymphatic routes in 118 patients. All the routes passed through the upper outer quadrant (UOQ) area, and there were more than 2 routes in 53 cases. Of these routes, 73% passed through only the UOQ area and 27% passed through the UOQ via the upper inner, lower inner, and/or lower outer quadrant area. Conclusions: We should confirm the sentinel lymphatic routes by using the ICG florescence method before BCS for preoperatively diagnosed DCIS. If the lymphatic routes do not pass over the extent of resection of BCS, we can omit SLNB in the first surgical treatment and await the final pathological result. However, we should perform SLNB in addition to BCS in cases in which the lymphatic routes pass over the tumor in the region except the UOQ area.

Isolated tumor cells versus micro-metastasis in sentinel lymph node biopsy for T1, T2 breast cancer compared to macro-metastasis: Significance after complete axillary dissection

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e12028-e12028
Author(s):  
Y. A. Alabdulkarim ◽  
E. Nassif
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Tumor Cells ◽  
Axillary Dissection ◽  
Lymph Node Biopsy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Isolated Tumor Cells ◽  
Lymph Node Examination

e12028 Background: Evaluating the axillary lymph nodes is extremely important in the management of breast cancer, with the recent improvement in histopathology techniques detection of micro-metastasis and even isolated cancer cells (ITC) in a setting of sentinel lymph node examination is feasible. In this study we aim to compare the outcome and significance of; positive SLN for macro versus Micro-metastasis, and ITCs. Methods: We reviewed all the patients who had SLN for breast cancer of stage T 1–2 between April 2006 and November 2008. Identifying all those who had positive macro-metastasis, micro-metastasis, or isolated tumor cells, pathology results of the full axillary LN dissection was evaluated for each type. Results: 350 patients had SLN of these 226 had a disease of T1–2, thirty seven patients (16.3%) had full axillary dissection, of these 27/37 had positive SLN for macro-metastasis, six had micro-metastasis and 3/37 had only ITCs. The presence of other LN metastasis was detected in 8 cases (21.6%); all of them were in the macro-metastasis group. No metastasis was found in either the micro-metastasis or the ITC groups. The ITC was only detected with DCIS; while micro-metastasis was present in DCIS or IDC. No relation was identified between the histopathology grade with ITC or micro-metastasis. Conclusions: Our findings did not show any presence of lymphatic metastasis after full axillary dissection, in case of positive micro-metastasis or ITCs in SLN, compared to the group of macro-metastasis. No significant financial relationships to disclose.

Intraocular Inflammatory Myofibroblastic Tumor With ALK Overexpression

2004 ◽  
Vol 128 (1) ◽  
pp. e5-e7
Author(s):  
Dennis P. O'Malley ◽  
Christopher Poulos ◽  
Magdalena Czader ◽  
Warren G. Sanger ◽  
Attilio Orazi
Keyword(s):  
Tumor Cells ◽  
Inflammatory Myofibroblastic Tumor ◽  
Plasma Cells ◽  
Smooth Muscle Actin ◽  
Chromosome 2 ◽  
Muscle Actin ◽  
Anaplastic Lymphoma ◽  
Spindle Cells ◽  
Multiple Copies

Abstract We report a case of an intraocular inflammatory myofibroblastic tumor nearly filling the vitreous cavity of the eye of a 50-year-old man. The tumor was composed of a mixture of spindle cells and mixed inflammatory elements, including numerous plasma cells. The differential diagnosis included inflammatory pseudotumor and neoplastic mimics of this condition. Further investigation with immunohistochemistry revealed the mass to be composed of myofibroblasts, positive for smooth muscle actin stains and with weak anaplastic lymphoma kinase (ALK) expression in some tumor cells. Evaluation by fluorescence in situ hybridization revealed the tumor cells to have multiple copies of chromosome 2 and ALK but no rearrangement of the ALK gene. The authors propose that multiple copies of the ALK gene may be involved in inflammatory myofibroblastic tumor tumorigenesis, in addition to ALK gene rearrangements.

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