scholarly journals Unilateral Orbital Metastasis as the Unique Symptom in the Onset of Breast Cancer in a Postmenopausal Woman: Case Report and Review of the Literature

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 725
Author(s):  
Cristina Marinela Oprean ◽  
Larisa Maria Badau ◽  
Nusa Alina Segarceanu ◽  
Andrei Dorin Ciocoiu ◽  
Ioana Alexandra Rivis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Postmenopausal Woman ◽  
Median Survival ◽  
Stage Iv ◽  
Left Breast ◽  
Pathological Examination ◽  
Adequate Treatment ◽  
Orbital Metastases ◽  
History Of

The orbit represents an unusual metastases site for patients diagnosed with cancer, however, breast cancer is the main cause of metastases at this level. These orbital metastases were discovered in patients with a history of breast cancer as unique or synchronous lesions. We present a rare case of a unique retroocular metastasis as the first initial symptom of a tubulo-lobular mammary carcinoma in a postmenopausal woman. A 57-year-old patient complains of diplopia, diminishing visual acuity, orbital tenderness, slight exophthalmia and ptosis of the left eyelid, with insidious onset. Clinical examination and subsequent investigations revealed a left breast cancer cT2 cN1 pM1 stage IV. Breast conserving surgery was performed on the left breast. Pathological examination with immunohistochemistry staining established the complete diagnostic: pT2pN3aM1 Stage IV breast cancer, luminal B subtype. After two years from the initial breast cancer diagnosis, the patient was diagnosed by the psychiatrist with a depressive disorder and was treated accordingly. Orbital metastases are usually discovered in known breast cancer patients and they are found in the context of a multi-system end-stage disease. Most reports cite that up to 25% of the total orbital metastases cases are discovered before the diagnosis of the primary tumor, as our case did. MRI is the gold standard for evaluating orbital tumors. The ILC histological subtype metastasizes in the orbitals more frequently than invasive ductal carcinoma. The prognosis of patients with orbital metastases is poor. The median survival after diagnosis of orbital metastases from a breast cancer primary is ranging from 22 to 31 months. Overall survival of our patient was 56 months, longer than the median survival reported in literature. Orbital metastases must be taken into account when patients accuse ophthalmologic symptoms even in the absence of a personal history of cancer. Objective examination of every patient that incriminates these types of symptoms is essential, and breast palpation must be made in every clinical setting. Orbital biopsy is necessary for the confirmation of the diagnosis and for an adequate treatment. Although recommendations for management of orbital metastases are controversial, it appears that multidisciplinary treatment of both metastases and primary cancer improves overall survival.

Induction of Immune Responses and Improved Survival after Infusions of T Cells Armed with Anti-CD3 X Anti-Her2/Neu Bispecific Antibody in Stage IV Breast Cancer Patients (Phase I).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2747-2747 ◽  
Author(s):  
Lawrence G. Lum ◽  
Ritesh Rathore ◽  
Don Dizon ◽  
Ding Wang ◽  
Zaid Al-Kadhimi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
T Cells ◽  
Immune Responses ◽  
Phase I ◽  
Median Survival ◽  
Bispecific Antibody ◽  
Stage Iv ◽  
Entire Study ◽  
Stage Iv Breast Cancer

Abstract Women with stage IV metastatic breast cancer (mBrCa) have limited treatment options since toxicities from chemotherapy and radiotherapy become limiting. Non-toxic immunotherapy approaches to improve targeting and cytotoxicity directed at breast cancer are needed. Our earlier study showed that anti-CD3 activated T cells (ATC) could be expanded in culture and then armed with anti-CD3 × anti-Her2/neu bispecific antibody (HER2Bi). The armed ATC mediate enhanced specific cytotoxicity, proliferate, and induce cytokine/chemokine secretion (J Hematotherapy & Stem Cell Res10:247, 2001). In a Phase I trial using ATC armed with Her2Bi, 18 Stage IV BrCa patients (pts) were treated with 8 infusions (twice/week) for 4 weeks totaling 40 (6 pts), 80 (2 pts), 160 (7 pts), and 320(1 pt) billion ATC armed with Her2Bi without dose-limiting toxicities. The most frequent side-effects were chills, fever, and hypotension that were easily controlled with medications. Two stage IV mBrCa patients had minor responses with decreases in CEA (35.2 to 4.1 ng/ml) or CA 27-29 (57.7 to 35.6 U/ml) and one pt had partial response with a decreased liver metastatic lesion. None of the pts developed human anti-mouse antibodies levels above10 ng/ml. Immunoaffinity-depletion of BiAb-armed ATC from PBMC of a high risk IV mBrCa pt at post-treatment time points showed an increase in anti-BrCa tumor cell activity exhibited by endogenous immune cells that persisted up to 4 months after treatment. Increasing proportions and absolute numbers of CD25+ cells in CD4+ and CD8+ subsets were observed as a function of treatment with nearly all CD4+ and CD8+ cells being CD25+ by 1 week post-final infusion. Significant treatment-associated elevations (several log increases over baseline) of circulating IFNγ, TNFα, IL-2, IL-5, IL-10, IL-12p70, and IL-13 were detected in serum of nearly all of the patients beginning 1–2 weeks after initiation of infusions. Particularly remarkable was the 3 log increase of mean (n=9) serum IL-12p70 from 0 to 1200 pg/ml. There was a Th1 shift that persisted during therapy. To date, results from the phase I clinical trial suggest that Her2Bi-armed ATC activate the endogeneous immune system to generate an adaptive immune responses despite the presence of high tumor burdens. The figure shows the overall survival for 18 women (All) treated on the phase I protocol with the median survival not yet defined for the HER2/neu 3+ group and the entire study group. The median survival for the 9 pts with Her2/neu negative disease was 21.5 months. Together these data are encouraging and strongly suggest infusions of armed targeted T cells may immunized the patient against their own tumor antigens leading to immunoreactivity manifested as the development of a persistent CTL response that may lead to improved overall survival. Figure Figure

Impact of HIV infection on overall survival among women with stage IV breast cancer in South Africa

2021 ◽  
Author(s):  
Yoanna S. Pumpalova ◽  
Oluwatosin A. Ayeni ◽  
Wenlong Carl Chen ◽  
Daniel S. O’Neil ◽  
Sarah Nietz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
South Africa ◽  
Overall Survival ◽  
Hiv Infection ◽  
Stage Iv ◽  
Stage Iv Breast Cancer

Surgery provides survival benefit over systemic therapy alone for stage IV triple negative breast cancer: A propensity matched analysis of the National Cancer Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13054-e13054
Author(s):  
Lifen Cao ◽  
Jonathan T. Bliggenstorfer ◽  
Kavin Sugumar ◽  
Christopher W. Towe ◽  
Pamela Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Triple Negative ◽  
Stage Iv ◽  
National Cancer Database ◽  
Propensity Matching ◽  
N Stage ◽  
Metastatic Sites

e13054 Background: Conflicting data exist regarding benefit of surgery of the primary site for stage IV breast cancer, in which systemic therapy is standard of care and patient characteristics may bias treatment decisions. Metastatic triple negative breast cancer (TNBC) is an aggressive subtype with limited therapy options and poor prognosis. Our aim was to assess whether surgery for the primary tumor in stage IV TNBC provides a survival advantage over systemic therapy alone. Methods: The National Cancer Database was queried for patients with de-novo stage IV TNBC who received systemic therapy alone or systemic therapy and surgery of the primary breast site 2004-2016. Patients receiving surgery for metastatic tumor sites or with incomplete follow up data were excluded. 1:1 propensity matching was performed for demographics, comorbidities, clinical T and N stage, and metastatic sites to minimize confounding factors. Survival outcomes were analyzed using a stratified log-rank test and Cox proportional hazard regression analysis. Results: Of 2989 patients, 782 (26.21%) underwent surgery plus systemic therapy and 2207 (73.84%) were treated with systemic therapy alone. The majority of all patients were aged 51-70 with low co-morbidity, and treated in metropolitan areas. Patients treated at academic facilities (OR = 0.67, p = 0.025), with multiple metastatic sites (OR = 0.59, p < 0.001), or advanced clinical N stage (OR = 0.55, p < 0.001) were less likely to undergo surgery. Of those who completed surgery, 58% had unilateral mastectomy, and 63% had axillary lymph node dissection. Propensity matching identified 507 ‘paired’ patients with similar characteristics in the surgery and systemic therapy alone groups. After multivariable adjustment, surgery was associated with superior overall survival compared with systemic therapy alone (HR 0.73, P < 0.001). Older age (HR = 1.47, p < 0.001), greater comorbidity (HR = 1.28, p < 0.001) and multiple metastatic sites (HR = 1.53, p < 0.001) significantly decreased overall survival in the matched cohort. Median survival was shortest in the systemic therapy alone group (12.8 months, 95% CI 11.3-14.5) and longest in those undergoing systemic therapy plus simple mastectomy (18 months, 95% CI 14.3-21.2), though approximately 4 months of median survival was added for all patients undergoing any surgery vs. systemic therapy alone (p = 0.0001). Conclusions: In stage IV TNBC, surgical resection of the primary tumor site in addition to systemic therapy may provide a survival benefit in selected patients. Though in this retrospective study the sequence of treatment was unknown, surgery could be considered for low disease burden as in other malignancies with oligometastatic disease. Additional research is needed to determine if these findings persist in prospective studies and for other hormone-receptor subtypes.

Case of second primary breast cancer in ectopic breast tissue and review of the literature

2021 ◽  
Vol 14 (4) ◽  
pp. e241361
Author(s):  
Jamin Kweku Addae ◽  
Thomas Genuit ◽  
Joseph Colletta ◽  
Kathy Schilling
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Breast Tissue ◽  
Delayed Diagnosis ◽  
Left Breast ◽  
Second Primary ◽  
Female Population ◽  
Accessory Breast ◽  
History Of ◽  
High Index Of Suspicion

Accessory breast tissue (ABT) is found in approximately 2%–6% of the female population and are subject to most of the physiological and pathological changes that occur in pectoral breast. Primary breast cancer occurring in ABT is a rare occurrence and a second primary breast cancer occurring in an accessory breast has never been reported. We report the case of a 60-year-old woman with a history of mastectomy for left breast cancer 5 years prior to presentation, who presented with an enlarging right axilla mass found to be a second primary breast cancer in an accessory tissue on biopsy. Many physicians are unfamiliar with the clinical presentation of accessory breast cancer due to the rarity of the condition and this ultimately results in delayed diagnosis and advanced disease at presentation. It is therefore prudent that physicians have a high index of suspicion when patients present with axillary masses.

scholarly journals Metastasis of breast cancer to bladder

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Asma Hadhri ◽  
Rim Abidi ◽  
Najet Mahjoub ◽  
Alia Mousli ◽  
Khalil Mahjoubi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lobular Carcinoma ◽  
Bladder Wall ◽  
Hormonal Treatment ◽  
Left Breast ◽  
Case Presentation ◽  
History Of ◽  
Bladder Metastasis ◽  
One Year ◽  
Immunohistochemical Studies

Abstract Background Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastasis. Urinary bladder metastasis from breast cancer is rarely reported in the literature. Case presentation We report a case of a 77-year-old female with history of left breast cancer, who presented a thickening of the bladder wall at pelvic ultrasound. Biopsy confirmed that the origin was lobular carcinoma of breast origin. The patient received chemotherapy, but the clinical course of the patient was very aggressive and she died one year later. Conclusion Bladder metastasis from breast cancer is rare, but the literature reveals an increase in such occurrence over the last few years. Pathologic diagnosis relies on immunohistochemical studies. Chemotherapy and hormonal treatment represent the standard therapy, with radiotherapy being used only to control bladder bleeding. The prognosis is usually poor.

Cancer disparities among patients with advanced metastatic breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18566-e18566
Author(s):  
Diana Saravia ◽  
Leah Elson ◽  
Hong Liang ◽  
Nadeem Bilani ◽  
Elizabeth Blessing Elimimian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Hormonal Therapy ◽  
Triple Negative ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Patient Characteristics ◽  
Receptor Status ◽  
Risk Of Death

e18566 Background: We previously elucidated sociodemographic factors associated with risk-of-death, in a subgroup of patients with Stage IV human epidermal growth factor 2 (HER)+ breast cancer. To further understand determinants of disparities in all subgroups of stage IV breast cancer, this study sought to evaluate factors which are predictive of overall survival (OS) in a cohort of patients with metastatic breast cancer (MBC), according to the following subtypes: 1) estrogen receptor (ER)+ or progesterone receptor (PR)+ and (HER)-, (2) (ER+ or PR+) and HER+, (3) (ER- and PR-) and HER-, or (4) (ER- and PR-) and HER+. Methods: Study population included patients with MBC, extracted from the National Cancer Database, treated between 2010 and 2016. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were performed to compare patient characteristics, by ethnic group (white, black, Hispanic, Asian, and other). Multivariate Cox regression models with backward elimination (using significance level of p<0.05) were utilized to compare overall survival among patient cohorts. In addition, Kaplan-Meier survival curves of patient cohort were also produced. Statistics were performed using SAS. Results: Records from n= 47,032 patients were included, the majority were 50 years or older, white, and treated with hormonal therapy. With a median follow-up time of 2.3 years, disparities in OS were observed; black patients were more likely to suffer death (HR=1.12 (1.08-1.16), p<0.0001), compared to white patients. Additional factors contributing to risk of death in MBC included: being male (HR=1.12, (1.02-1.23), p=0.019), having visceral involvement compared to bone only (HR=1.52, (1.05-1.28), p<0.0001), income < $38,000 (HR=1.13 (1.09-1.17), p<0.0001), being on government insurance (HR=1.24, (1.20-1.27), p<0.0001, and having Triple Negative Breast Cancer (ER- and PR-) and HER- status (HR=1.68 (1.60-1.75) p<0.0001). Patients who receive chemotherapy, not hormonal therapy (HR=1.25 (1.2 – 1.3), p<0.0001), were found to have worse prognosis possibly reflecting biology of disease at presentation and lack of specific targeted therapy. Conclusions: This study confirms that sociodemographic disparities exist in OS among patients within the same stage of MBC, and regardless of receptor status subtypes. Clinical practice should focus on closing disparities gaps for those with advanced and MBC, especially among Black, impoverished, and male patients. Better treatment approaches should be sought for patients with visceral metastasis and those diagnosed with triple negative receptor status, who continue to suffer from worse outcomes.

scholarly journals Pseudofungi in an Immunocompromised Patient with Breast Cancer and COVID-19

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Nadeem Bilani ◽  
Leah Elson ◽  
Diane Carlson ◽  
Elizabeth Blessing Elimimian ◽  
Zeina Nahleh
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Male Patient ◽  
Immunocompromised Patient ◽  
Recent History ◽  
Pathological Examination ◽  
History Of

Herein, we present a case of a male patient with breast cancer and a recent history of COVID-19 pneumonia, diagnosed with pseudofungi on pathological examination of lymph nodes after mastectomy. Pseudofungi are septate hyphae-like structures that morphologically mimic fungal elements despite the absence of true mycosis and thus predispose to overtreatment if not properly identified. We report a review of similar cases involving this diagnostic mimicker in the literature.

scholarly journals Metastatic behavior and overall survival according to breast cancer subtypes in stage IV inflammatory breast cancer

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
D. J. P. van Uden ◽  
M. C. van Maaren ◽  
L. J. A. Strobbe ◽  
P. Bult ◽  
J. J. van der Hoeven ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Inflammatory Breast Cancer ◽  
Lung Metastases ◽  
Multivariable Analysis ◽  
Stage Iv ◽  
Breast Cancer Subtypes ◽  
Rank Test ◽  
Metastatic Site ◽  
Cancer Subtypes

Abstract Background Distant metastatic disease is frequently observed in inflammatory breast cancer (IBC), with a poor prognosis as a consequence. The aim of this study was to analyze the association of hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) based breast cancer subtypes in stage IV inflammatory breast cancer (IBC) with preferential site of distant metastases and overall survival (OS). Methods For patients with stage IV IBC, diagnosed in the Netherlands between 2005 and 2016, tumors were classified into four breast cancer subtypes: HR+/HER2−, HR+/HER2+, HR−/HER2+, and HR−/HER2−. Patient, tumor, and treatment characteristics and sites of metastases were compared. OS of the subtypes was compared using Kaplan-Meier curves and the log-rank test. Association between subtype and OS was assessed in multivariable models using logistic regression. Results In total, 744 eligible patients were included: 340 (45.7%) tumors were HR+/HER2−, 148 (19.9%) HR−/HER2+, 131 (17.6%) HR+/HER2+, and 125 (16.8%) HR−/HER2−. Bone was the most common metastatic site in all subtypes. A significant predominance of bone metastases was found in HR+/HER2− IBC (71.5%), and liver and lung metastases in the HR−/HER2+ (41.2%) and HR−/HER2− (40.8%) subtypes, respectively. In multivariable analysis, the HR−/HER2− subtype was associated with significantly worse OS as compared to the other subtypes. Conclusion Breast cancer subtypes in stage IV IBC are associated with distinct patterns of metastatic spread and display notable differences in OS. The use of breast cancer subtypes can guide a more patient-tailored staging directed to metastatic site and extend of disease.

scholarly journals Improved Overall Survival after Contralateral Risk-Reducing Mastectomy in Brca1/2 Mutation Carriers with a History of Unilateral Breast Cancer: A Prospective Analysis

2014 ◽  
pp. n/a-n/a ◽  
Author(s):  
Bernadette AM Heemskerk-Gerritsen ◽  
Matti A Rookus ◽  
Cora M Aalfs ◽  
Margreet GEM Aussems ◽  
Johanna M Collée ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Prospective Analysis ◽  
Unilateral Breast Cancer ◽  
Mutation Carriers ◽  
History Of ◽  
Risk Reducing
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