Primary and Secondary Angiosarcoma of the Breast: Report of Two Cases and Review of the Literature

Introduction: The breast's angiosarcoma is a rare entity, representing 1% of the breast's malignant neoplasms and is classified as primary and secondary; the latter is associated with radiotherapy and chronic lymphedema. Clinically both present as a voluminous and rapidly growing lesion. Surgery is the cornerstone of a treatment since it provides the most outstanding local control, whereas radiotherapy and chemotherapy have little impact on the disease. Similarly, the oncological prognosis is poor because this type of tumor has a high recurrence rate and overall, 5-year survival of only 20%. Objective: Two cases of angiosarcoma of the breast (primary and secondary) are reported, both treated in the Breast Tumor Service and a bibliographic review of the disease is presented. Materials and Methods: All breast cancer cases were reviewed in the Breast Tumor Service for two years. Results: In the first clinical case, a 61-year-old patient was presented with a 5-month-old primary angiosarcoma in the right breast, treated with modified radical mastectomy. While in the second case, the clinical history of a 76-year-old woman with secondary breast angiosarcoma is related; the patient had a history of right breast cancer, treated ten years previously with conservative surgery, sentinel node and adjuvant radiotherapy. However, the woman presented local recurrence six years later, and she was operated on with a total mastectomy. Three years later, she developed an angiosarcoma in the surgical bed that warranted a wide resection of the chest wall. Conclusion: The breast's angiosarcoma is an aggressive and rare tumor of unknown aetiology, since it has a high recurrence rate and poor survival. Its main prognostic factors are tumor volume and resection margins. Therefore, early diagnosis is essential because it allows complete resection of the lesion.

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Radiotherapy for Recurrent Keloid: A Case Report

Journal of Biomedicine and Translational Research ◽

10.14710/jbtr.v6i3.8473 ◽

2020 ◽

Vol 6 (3) ◽

pp. 89-91

Author(s):

Christina Hari Nawangsih Prihharsanti ◽

Muhamad Rizqi Setyarto ◽

Dion Firli Bramantyo

Keyword(s):

Connective Tissue ◽

Recurrence Rate ◽

Corticosteroid Injection ◽

Inflammatory Cells ◽

Early Postoperative Period ◽

High Recurrence Rate ◽

Surrounding Soft Tissue ◽

History Of

Background: Keloid is a benign growth of connective tissue. There are several risk factors that play a role in keloid growth. Excision surgery is one of the modalities in the treatment of keloids. However, excision surgery alone has a recurrence rate of 45-100%.Case: Male, 37 years old, with complaints arising from a keloid lesions in the left earlobe since three years ago with a history of previous injuries. The lesions is then operated on but always grows back postoperatively. The number of surgeries that have been carried out three times with further treatment in the form of corticosteroid injection. However, keloid still recurrence. Finally it was decided to undergo treatment with surgery followed by radiotherapy within a period of no more than 24 hours postoperatively. Follow-up after six months gave good results without recurrence.Discussion: Keloid has a high recurrence rate after excision surgery. Surgery followed by radiotherapy has a low recurrence rate compared to surgery or surgery followed by administration of corticosteroid injections. Radiotherapy as adjuvant therapy for postoperative keloid excision has the role of sterilizing the connective tissue stem cell active fibroblasts and acute inflammatory cells that grow in the early postoperative period. A study states that administration of postoperative radiation with electrons in keloids in the earlobe at a dose of 15 Gy in three fractions gives a low recurrence rate and a low risk of side effects in the surrounding soft tissue.

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The History of Mastectomy

The American Surgeon ◽

10.1177/000313481107700515 ◽

2011 ◽

Vol 77 (5) ◽

pp. 566-571 ◽

Cited By ~ 6

Author(s):

Marios Loukas ◽

R. Shane Tubbs ◽

Nadine Mirzayan ◽

Michelle Shirak ◽

Ashley Steinberg ◽

...

Keyword(s):

Breast Cancer ◽

20Th Century ◽

Upper Limb ◽

Breast Tissue ◽

Surgical Techniques ◽

Radical Mastectomy ◽

Large Impact ◽

Surgical Tools ◽

History Of ◽

Surgical Field

The mastectomy that is performed today is a procedure born from hundreds of years of discoveries, inventions, and amendments to existing surgical techniques. The reasons for performing this extreme surgery have changed as well, ranging from unilateral breast removal to allow greater upper limb functionality to bilateral removal of the breasts or breast tissue in individuals predisposed to breast cancer or in individuals who have already been diagnosed. The additions of surgical tools and anesthetics to the field of medicine further transformed the surgical field in general and had a large impact on the mastectomy. William Halsted's radical mastectomy served as the basis of most future breast removal techniques, and it the method recognized today as the “radical mastectomy.” Most radical surgeries are currently used for prophylaxis, whereas less invasive lumpectomies have eclipsed breast removal surgeries as of the latter half of the 20th century.

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Is Surgery Justifiable in Residual Locally Advance Breast Cancer After Neo-Adjuvant Systemic Treatment?

Journal of Bioscience & Biomedical Engineering ◽

10.47485/2693-2504.1001 ◽

2020 ◽

Keyword(s):

Breast Cancer ◽

Recurrence Rate ◽

Triple Negative ◽

Residual Disease ◽

Locally Advanced ◽

Tumor Biology ◽

Radical Mastectomy ◽

Her2 Status ◽

Systemic Recurrence ◽

Time To Recurrence

Background: Management of locally advanced disease is a challenge. In women with significant residual disease after neoadjuvant therapy when subjected to surgery wounds cannot be closed primarily and require myo-cutaneous flap, Latismus dorsi being the easiest one. The purpose of this study is to look at the recurrence rate, time to recurrence and is surgery needed in this group of patients. Material and Methods: This is a hospital-based retrospective study conducted at Liaquat National Hospital and Medical College, Karachi. Pakistan. From 2006 to 2015, 15 patients with locally advanced breast cancer, who still had significant residual disease after adequate neo-adjuvant therapy that after Modified radical mastectomy wound could not be closed and latismus dorsi flap was used to close the defect. The age, histopathology report, margin of clearance, ER, PR, Her2 status and ki67 was noted. These patients were followed up to look for any local or systemic recurrence and time to recurrence and local or site of any systemic recurrence was recorded. Results: A total of 15 female patients with a mean age of 42.73±9.66 years with a mean follow up of 33.93±26.78 months were seen. In all patients, margins were histologically negative. Mean nodes removed and involved were 12.53±8.04 and 5.46±7.15 respectively. Meantime to recurrence was 16.00±14.92 months. In our study, recurrence was observed in 11 (73.3%) patients with 7(64 %) local and 4(36%) systemic recurrence. All 5 triple-negative and 4 patients stage IV 4 had local recurrence. Patients with poor prognostic markers like higher residual nodal involvement, large tumor size, higher Ki 67, aggressive tumor biology (triple-negative and HER2 Positive tumors) had a high and early recurrence. Conclusion: In patients with high residual tumor burden and aggressive biology has high chances of disease recurrence. Surgery in these patients should be offered to keep quality of life, disease biology and recurrence rate in mind.

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Metachronous or synchronous male breast and prostate cancers a duality to lookout for.

F1000Research ◽

10.12688/f1000research.16997.1 ◽

2018 ◽

Vol 7 ◽

pp. 1825

Author(s):

Alain Mwamba Mukendi ◽

Eunice Van Den Berg ◽

Sugeshnee Pather ◽

Rushen Siva Padayachee

Keyword(s):

Breast Cancer ◽

Prostate Cancer ◽

Prostate Biopsy ◽

Bone Scan ◽

Digital Rectal Examination ◽

Radical Mastectomy ◽

Modified Radical Mastectomy ◽

Breast Lump ◽

History Of ◽

Prostate Cancers

Introduction: Breast cancer is well known as the stereotypical women's cancer, and prostate cancer represents the well-known stereotypical male counterpart. While prostate cancer carries the potential to metastasize to the breast, the synchronous or metachronous co-occurrence of primary breast and primary prostate cancers is quite unusual. Prostate cancer in men of African descent may have its own behavior with regards to its relationship with male breast cancer. Case presentation: Case 1: A 64 year old male presented to Chris Hani Baragwanath Hospital (CHBAH) with a 2 years history of a painless left breast lump. A core biopsy was confirmed breast carcinoma. Tamoxifen was started but, due to disease progression, he underwent left modified radical mastectomy followed by chemotherapy. Prostate biopsy was done for raised Prostate Specific Antigen (PSA) and suspicious prostate on digital rectal examination. A prostatic adenocarcinoma was subsequently diagnosed with bone metastasis on bone scan. He was started on Androgen deprivation therapy and followed up every 3 months. Case 2: A 68 year old male presented to CHBAH with a 1 year history of a painless right breast lump. A core biopsy confirmed breast cancer. Tamoxifen was started, followed by right modified radical mastectomy and chemotherapy for disease progression. A raised PSA and suspicious prostate on digital rectal examination prompted a prostate biopsy revealing a prostatic adenocarcinoma. Bone scan was negative for metastasis. He is currently on 3 monthly Androgen deprivation therapy and awaiting radiation. Conclusion: This clinical practice article not only presents this exceptionally rare duality but highlights that both cancers can coexist either as sporadic conditions, or as a result of genetic mutations. Thus, we suggest that men with prostate cancer be screened clinically, biochemically and genetically for breast cancer and vice versa.

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Assessment of predictors and prognostic factors for locoregional recurrent breast cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20185489 ◽

2018 ◽

Vol 6 (1) ◽

pp. 287

Author(s):

Hossam A. Elfol ◽

Tarek M. Rageh ◽

Mohammed A. Hamed

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Safety Margin ◽

Radical Mastectomy ◽

Recurrent Breast Cancer ◽

Oral Contraceptive Pills ◽

Female Patients ◽

History Of ◽

Recurrent Breast ◽

Locoregional Recurrent Breast Cancer

Background: Assessment of predictors and prognostic factors of locoregional recurrent breast cancer will help in management of those patients. The aim of this study was to assess and identify the predictors and prognostic factors for locoregional current breast cancer.Methods: This prospective study will be carried out on 50 female patients with history of breast cancer underwent surgical procedures either modified radical mastectomy (MRM) or conservative breast surgery (CBS) and adjuvant therapy (chemotherapy, radiotherapy, hormonal therapy).Results: Significant relationship between recurrence of breast cancer and Oral contraceptive pills of the studied female patients with history of breast cancer underwent surgery.Conclusions: Number of positive lymph nodes, lympho-vascular invasion, positive safety margin and presence of extensive intra-ductal component all these factors increase risk of recurrent breast cancer.

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Locally Advanced Breast Cancer in the Elderly: Curettage Mastectomy

Tumori Journal ◽

10.1177/030089160509100407 ◽

2005 ◽

Vol 91 (4) ◽

pp. 321-324 ◽

Cited By ~ 4

Author(s):

Mario Solej ◽

Marco Ferronato ◽

Mario Nano

Keyword(s):

Breast Cancer ◽

Breast Tumor ◽

Elderly Women ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Radical Mastectomy ◽

The Elderly ◽

Pectoral Muscle ◽

Advanced Breast ◽

Local Regional Recurrence

Aims and background Locally advanced breast tumor represents 5–20% of new cases diagnosed every year. The purpose of this study was to report our experience and to compare it with the literature. Methods From 1998 to 2003 at the Molinette Hospital in the Turin University Third Division of General Surgery, there were 34 cases of breast cancer in older women (between 70 and 94 years of age), 14 of which (41.18%) were locally advanced breast tumor. We evaluated the type of surgical intervention and anesthesia used, muscular invasion, the presence of receptors positive to estrogens and progesterone, the operative mortality, the percentage of local-regional recurrence, and relapses after a period of time. Results Among the patients with locally advanced breast tumor, 21.43% (3/14) were at stage MIA and 78.57% (11/14) at stage IIIB. In 14.29% (2/14) of the cases, Patey's radical mastectomy was performed, in 57.14% (8/14) Halsted's radical mastectomy, and in 28.57% (4/14) a simple mastectomy with the removal of the fascia of the major pectoral muscle. Three (21.43%) patients underwent a second intervention for local-regional disease. None of the patients had distant metastasis in the first 2 years after the operation. Mortality after 2 years was 23.1% (3/13). None of the patients who underwent surgery had adjuvant therapy, usually because it was refused by the patients themselves or their families. All the negative and positive hormone receptor patients received tamoxifen. Conclusions Locally advanced breast tumors are frequent in elderly women. In the past, there has been a tendency to surgical under-treatment. As regards locally advanced breast tumor, curettage operations represent the only possibility to improve the quality of life of the elderly. These should be performed after carefully evaluating a series of variables in the general and local condition of the patient, the aggressiveness of the intervention and the life expectancy.

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Trends in rates of modified radical mastectomies and bilateral mastectomies in unilateral breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.569 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 569-569

Author(s):

Ajaz Bulbul ◽

Tareq Braik ◽

Sadaf Rashad ◽

Emilio Araujo Mino ◽

Adrianna Bautista ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Clinical Outcomes ◽

Recurrence Rate ◽

Early Stage ◽

Breast Conservation ◽

Radical Mastectomy ◽

Breast Conservation Surgery ◽

Bilateral Mastectomy ◽

Unilateral Breast Cancer

569 Background: Women with unilateral breast cancer (BC) without genetic predisposition have a low risk for local and contralateral recurrence with breast conservation surgery (BCS) and adjuvant treatment. We aimed to study the pattern of surgical care across centers in rural New Mexico and its correlation to clinical outcomes. Methods: We retrospectively evaluated 533 patients with Stage 1-3 BC diagnosed between January 1989 to October 2015. Clinical Outcomes with BCS, sentinel lymph node dissection (SLND), simple mastectomy (SM), modified radical mastectomy (MRM) and Bilateral Mastectomy (BM) were studied. Descriptive statistics were performed to describe the proportion of surgery types. Predictors of clinical outcomes were evaluated by multivariate logistic regression. Results: Out of 533 patients, 510 (82%) had early stage (0-3) resectable BC. Among these, 48% (246/510) had either MRM (209/510) or BM (37/510). MRM was performed in 3% of stage 0 (6/209), 23% (49/209) stage I, 46%(97/209) of stage II and 27% (57/209) of Stage III patients. Overall, the rate of SLND was 42% among Early stage Breast cancer. Of 41 patients treated with bilateral mastectomy, 10 were positive for BRCA mutation, 6 for family history and 3 for contralateral disease. Median age of BM was 53 +12 y. The local recurrence rate was 8.8% (45/510), and metastatic recurrence rate was 15.5% (79/510). Lymphedema rate was 9.2% (47/510). Using MRM as reference, the Odds Ratio (OR) for lymphedema after BM and BCT were 2.15 (95% CI, 0.84-5.50) and 0.58 (0.28-1.22), respectively. With 9.6 years of median follow up, the predictive probabilities of lymphedema after BCT, SM, MRM and BM were 1%, 4%, 9% and 18%. The OR for local recurrence in women with BCT were 1.46 (95th C/I: 0.72-2.95), SM 0.27 (0.03-2.13), BM 2.06 (95th C/I:0.70-6.06). Conclusions: Less BCT and more aggressive procedures are being performed, and the latter is associated with more lymphedema. No significant differences were noted in local recurrences. Presence of a genetic mutation was not the sole indicator of BM’s in our patient population. There is a need for evidence-based shared decision-making and surgical management of breast cancer, especially in a rural community setting.

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Rapid Response of Breast Cancer Cutaneous Metastasis to Single-Agent Palbociclib: A Case Report

Chemotherapy ◽

10.1159/000512499 ◽

2021 ◽

pp. 1-3

Author(s):

Sami Droubi ◽

Anum Aqsa ◽

Maryam Rehan ◽

Meekoo Dhar

Keyword(s):

Breast Cancer ◽

Cancer Progression ◽

Histopathological Examination ◽

Single Agent ◽

Metastatic Breast ◽

Radical Mastectomy ◽

Cutaneous Metastasis ◽

Breast Adenocarcinoma ◽

Prior History ◽

History Of

Palbociclib is a cyclin-dependent kinase (CDK) 4/6 inhibitor. Palbociclib combined with endocrine therapy has shown promising results in hormone-receptor-positive (HR+) and human epidermal growth factor receptor-negative (HER-2−) breast cancer progression. We present a case of a woman with a history of infiltrating lobular cancer of the left breast, status post modified radical mastectomy 6 years prior, presenting with nodular erythematous lesions on the left arm and back. Histopathological examination confirmed the diagnosis of recurrent metastatic breast adenocarcinoma. She had complete resolution of cutaneous metastasis with 1 cycle of Palbociclib. We believe our case is unique as the resolution of cutaneous metastasis with 1 cycle of single-agent Palbociclib is rare. Furthermore, it highlights the importance of considering cutaneous metastasis as a possibility in patients with prior history of primary internal malignancy.

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Prophylactic Mastectomy

Archives of Pathology & Laboratory Medicine ◽

10.5858/2000-124-0378-pmpfih ◽

2000 ◽

Vol 124 (3) ◽

pp. 378-381 ◽

Cited By ~ 2

Author(s):

Kamal K. Khurana ◽

Anne Loosmann ◽

Patricia J. Numann ◽

Seema A. Khan

Keyword(s):

Breast Cancer ◽

Family History ◽

Prophylactic Mastectomy ◽

Positive Family History ◽

Reduction Mammoplasty ◽

Malignant Neoplasms ◽

Atypical Lobular Hyperplasia ◽

Pathologic Findings ◽

History Of ◽

The Mean

Abstract Background.—According to recently published data, prophylactic mastectomy (PM) appears to prevent about 90% of the expected malignant neoplasms in women with a family history of breast cancer. Objectives.—To identify the frequency of high-risk lesions in PM specimens and to determine occurrence of any new primary breast cancer following PM. Design.—We performed a retrospective study of women undergoing unilateral or bilateral PM. Medical charts and pathologic findings of 35 patients who underwent bilateral mastectomies at University Hospital, Syracuse, NY, from 1989 to 1996 were reviewed. Patients with biopsy-proven bilateral breast cancer were excluded. Patients were divided into 3 groups: (A) positive family history and no known breast cancer (n = 9), (B) positive family history and contralateral neoplasia (n = 13), and (C) negative family history and contralateral neoplasia (n = 13). These findings were compared with those found in reduction mammoplasty specimens from 10 women at standard risk of breast cancer. Results.—The mean age of the control group of women undergoing reduction mammoplasty was 38 years. The pathologic specimens demonstrated no significant pathologic findings in 9 and fibrocystic change in 1. In group A, the mean number of affected relatives was 3.1, and the mean age was 38 years. Two of these 9 women had atypical duct hyperplasia and 1 had atypical lobular hyperplasia in their breasts (ie, 33% with high-risk pathologic findings). Of the 13 group B women (mean age, 46.6 years; mean of 2.5 affected relatives and unilateral breast cancer), the contralateral PM specimen contained duct carcinoma in situ in one and invasive ductal cancer in a second (15% with occult malignant neoplasms). In 13 group C patients (mean age, 47.1 years), 3 (23.1%) of the contralateral PM specimens displayed atypical duct hyperplasia or atypical lobular hyperplasia. At a mean follow-up of 4.8 years, there have been no new breast malignant neoplasms in these 45 women. Conclusions.—The occurrence of unilateral cancer in patients with family history of breast cancer is associated with a 15.4% probability of simultaneous occult malignant neoplasms in the contralateral breast. Patients with a strong family history but no evidence of breast cancer have a substantially similar rate of proliferative disease in their PM specimens as those women who have unilateral cancer but no significant family history.

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Retrospective analysis on patients with male breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19681 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19681-19681

Author(s):

A. M. Alvarez ◽

M. N. Gandur Quiroga ◽

G. Cinat ◽

J. Iturbe ◽

T. Said Nissi ◽

...

Keyword(s):

Breast Cancer ◽

Male Breast Cancer ◽

Ductal Carcinoma ◽

Lobular Carcinoma ◽

Radical Mastectomy ◽

Male Breast ◽

History Of ◽

The Media ◽

Histological Characteristics ◽

Breast Lumps

19681 Background: Male breast cancer is uncommon, 1%(0.7 %)of all breast cancer. Nevertheless, the incidence has climbed 26% over the past 25 years. Objetive: Analyze the form of presentation and clinical evolution of patients with male breast cancer studied from 1977 to 2005. Methods: From 1977 to 2005 53 charts were analyzed: age, clinical presentation, stage (st), histological characteristics and nodal involvement. Results: Age: 33 years to 83 years (median= 59 years). Mean durations of symptoms before presentations: 11 months (m) (range 1 - 84 m.) . Forty-six (86.7%) patients (pts) had history of breast lumps, 9 (17%) were painful. Skin involvement and ulceration were present in 5 (9.43%) and 4 (7.54 %) respectively. One case of bilateralism was found. Seven (13.2%) st. I; 18 (33.96%) st. II; 20 (37.73%) st. III and 7 (13.2%) st. IV. Radical mastectomy was done in 41 pts (77.35%). Invasive ductal carcinoma was the most common histological type in 45 (84.9%). One case of lobular carcinoma was found. 60.4% of tumours expressed hormonal receptor. Adyuvant treatment: Adriamycin-based chemotherapy in 20 pts and CMF in 8 pts. Hormonotherapy was offered in 10 (19%) pts of the previous group, radiotherapy to 12 pts. twenthy pts (37.73%) presented recurrence; most common was bone in 10. The st. I and II estimated 5-year survival rate was 68% IC 95% (44–84%), st. III was 44% IC 95% (23 - 67%), st. IV (median = 24 m) with range (16 - 56 m). The 72% IC 95% (48–88%) patients st. I and II was free of disease at the 5-years, st. III was free 24% IC 95% (9–49%), st. IV (median = 7,5 m) with range (7–14 m). Conclusions: The media age at diagnosis was 59 years (10 years less than the international bibliography). (IB). Our group had longer time to presentation: 11 vs. 6 m., (IB) and most of them where in st. III. Hormonal receptore were positive in 60%. No significant financial relationships to disclose.

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