Metastatic Carcinoma Breast Presenting as Appendicular Abscess

Breast cancer is the most common cancer in females worldwide and presents mostly as a hard painless lump in breast. Authors report a case of a 59-year-old female who presented to emergency department with complaints of pain and lump in right iliac fossa, high grade fever with chills and rigor, multiple episodes of vomiting. She was febrile having tachycardia with normal blood pressure. Examination revealed a firm tender lump in right iliac fossa with guarding of abdomen. Incidental finding of a large left sided breast lump was noted. Radiological investigations revealed appendicular abscess. She was undertaken for emergency diagnostic laparoscopy followed by appendectomy. Surprisingly, histopathology revealed deposits of ductal carcinoma in appendix. She developed faecal fistula at incision site. On further evaluation of left breast lump it was diagnosed as locally advanced breast carcinoma. Patient was managed with neo-adjuvant chemotherapy followed by left sided Modified Radical Mastectomy (MRM) and adjuvant chemotherapy. She was on regular follow-up since then. Appendicular metastasis is one of the rare sites of metastasis of breast malignancy and presentation as appendicular abscess made the diagnosis and management challenging.

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Bilateral Neuroendocrine Carcinoma of Breast: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.6997 ◽

2021 ◽

Vol 59 (244) ◽

pp. 1320-1322

Author(s):

Sulochana Neupane ◽

Sanam Dhakal ◽

Shripad Walawalakar ◽

Surya Bahadur Parajuli ◽

Sulav Sapkota

Keyword(s):

Ductal Carcinoma ◽

Neuroendocrine Differentiation ◽

Radical Mastectomy ◽

Left Breast ◽

Breast Cancers ◽

Breast Carcinomas ◽

Breast Lump ◽

History Of ◽

Poorly Differentiated ◽

Neuroendocrine Carcinomas

Primary neuroendocrine carcinomas of the breast are rare of all breast carcinomas. They may be welldifferentiated, poorly differentiated, or invasive breast cancers with neuroendocrine differentiation. They are staged and treated similarly to conventional breast cancer. Herein, we report a case of invasive ductal carcinoma with neuroendocrine differentiation of the breast in a 73 years female with a history of breast lump initially in the lower inner quadrant of left breast and a month later, similar lump at the same site in right breast. Patient underwent Modified Radical Mastectomy bilaterally followed by adjuvant chemotherapy based on Carboplatin and Etoposide regimen.

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Trastuzumab induced radiation recall dermatitis: an interesting case

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20184868 ◽

2018 ◽

Vol 7 (12) ◽

pp. 2465

Author(s):

Anupama C. ◽

Anuradha H. V. ◽

Vinayak V. Maka

Keyword(s):

Ductal Carcinoma ◽

Growth Factor Receptor ◽

Radical Mastectomy ◽

Left Breast ◽

Interesting Case ◽

Axillary Lymph ◽

Radiation Recall ◽

Skin Reactions ◽

Radiation Recall Dermatitis ◽

Recall Dermatitis

Radiation recall dermatitis (RRD) is the appearance of skin reactions in previously irradiated skin which is triggered by the administration of certain drugs. Surgery, chemotherapy, and radiotherapy are the mainstay of treatment in breast cancer. RRD induced by trastuzumab has been rarely reported in India. This is a case report of a 56-year-old woman presented to the medical oncology outpatient department of our hospital with breast lump, and she was diagnosed to have human epidermal growth factor receptor 2 (HER-2/neu) positive invasive ductal carcinoma of left breast of stage T2N3cM0. She was treated with neoadjuvant chemotherapy, and she underwent modified radical mastectomy with axillary lymph node dissection. The treating oncologist was planned to start on adjuvant chemotherapy with injection trastuzumab for every four weeks, for 15 cycles. Patient received first dose of injection trastuzumab (450 mg) intravenously in the right (contralateral) arm and developed painful, swollen, erythematous blisters, and maculopapular rashes following the sharp linear borders of her previous radiation fields. She was reviewed by the medical oncologist and diagnosed as a rare case of RRD and treated with topical betamethasone cream. Causality assessment for RRD to trastuzumab was done using Naranjo and WHO-UMC scale and found to be in the category of probable and probable/ likely respectively.

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Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy

International Journal of Breast Cancer ◽

10.1155/2015/536145 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Dhanya Vasudevan ◽

P. S. Jayalakshmy ◽

Suresh Kumar ◽

Siji Mathew

Keyword(s):

Breast Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Tumor Response ◽

Ductal Carcinoma ◽

Locally Advanced ◽

Radical Mastectomy ◽

Tumor Characteristics ◽

Modified Radical Mastectomy ◽

Tumor Bed

Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT) in the setting of locally advanced breast cancer (LABC) can render inoperable tumor (T4, N2/N3) resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response.Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n=48) were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier’s system which graded the responses into pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR).Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2–5 cms) and Bloom Richardson’s grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed.Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.

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Breast cancer in young women less than 30 years from southern India: Study on clinical profile and outcome

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e22196 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e22196-e22196

Author(s):

R. Rejiv ◽

D. Biswajit ◽

R. Neelesh ◽

V. Sridevi ◽

T. G. Sagar ◽

...

Keyword(s):

Breast Cancer ◽

Hormone Receptor ◽

Ductal Carcinoma ◽

Locally Advanced ◽

Young Patients ◽

Stage Iv ◽

Radical Mastectomy ◽

Reproductive Age ◽

Breast Cancer Patients ◽

Pregnancy And Lactation

e22196 Background: Breast cancer in young patients have an aggressive behaviour with poorer outcome. The patients are in their reproductive age group and are concerned with fertility issues,pregnancy and lactation. The literature pertaining to patients less than 30 years is limited. Methods: 213 Patients under the age of 30 years with breast cancer were studied for Demographics, clinical presentations, pathological profiles, treatment and survival. The case records were retrospectively analyzed between Jan 1993 - Dec 2003 at Cancer Institute (WIA) Chennai. Results: The mean age of the study population was 28 years and ranged between 17 to 30 years. Early menarche, defined as less than 12 years (17.5 %), Nulliparity (21.1%), first child birth less than 18 years (26.8%) were the major risk factors noted. Family history of breast and ovarian cases were seen in 6.6% of the patients. The Stage distribution included Stage I (1.4%), Stage II (31%), Stage III (49.6) and Stage IV (11%) and unclassifiable (7%). Node positive tumours constituted 158 patients (74.1%). Hormone receptor studies were negative in 62% of the patients. Modified radical mastectomy was performed in 164 (77%) of the patients. Non infiltratring ductal carcinoma histopathology was noted in 13.6%. Surgical and radiocastration was performed in 35.2% and 17% of the cases respectively. Of 201 (94.3%) patients who received chemotherapy anthracycline based chemotherapy was delivered in 30.3%. Recurrence pattern included local, local and distant and distant recuurences in 8.5%, 23.5% and 2.3% respectively. The 5 year over all survival for the evaluable patients was 53.2%. Conclusions: Very young Indian patients less than 30 years constitute a unique subset of breast cancer patients with majority being hormone receptor negative and locally advanced stage at presentation. The over all outcome is inferior compared to older patients with breast cancer. More aggressive adjuvant treatment may help in improving survival. No significant financial relationships to disclose.

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Locally advanced breast cancer in younger women

Archive of oncology ◽

10.2298/aoo0303149l ◽

2003 ◽

Vol 11 (3) ◽

pp. 149-149

Author(s):

Jadranka Lakicevic ◽

Dinka Lakic ◽

Milan Sorat

Keyword(s):

Breast Cancer ◽

Surgical Treatment ◽

Adjuvant Chemotherapy ◽

Advanced Breast Cancer ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Radical Mastectomy ◽

Breast Conserving Surgery ◽

Advanced Breast ◽

Neo Adjuvant Chemotherapy

Background: Standard treatment of locally advanced breast cancer is not yet established. In most institutions treatment is multimodal and consists of primary chemotherapy, surgical treatment with or without radiotherapy (RT) and hormonal therapy. To find out whether the age influences the kind of surgical treatment in a group of locally advanced breast cancer patients (LABC patients) responding to neo-adjuvant chemotherapy. Methods: Analysis included 39 LABC patients treated from January 2000 till January 2003 with neo-adjuvant chemotherapy and surgical treatment in Clinical Center of Montenegro, Podgorica. All patients had locally advanced disease (T2, T3 or T4b and/or N1-2 M1 sc). Patients with T4d tumors were excluded. The treatment consisted of neo-adjuvant chemotherapy, mostly anthracycline based, and surgical treatment - radical mastectomy or breast conserving surgery. Additional procedures after surgical treatment included 3-4 cycles of the same chemotherapy, hormonal treatment and/or RT. Results: Median age of patients was 47 years (range: 24-67 years). Thirty patients were initially in stage IIIA (14 post- and 16 premenopausal patients respectively), 6 patients in stage IIIB (2 post- and 4 premenopausal respectively), and 3 patients in stage IV, with supraclavicular node involvement (M1+sc, 2 post- and 1 premenopausal, respectively). Applied preoperative chemotherapy was anthracycline-based regimen (FAC, 3-6 cycles) except in one patient in premenopausal group and 2 patients in postmenopausal group, who had been treated with CMF chemotherapy due to anthracycline contraindications. All analyzed patients responded to neo-adjuvant chemotherapy, mostly with partial or minimal remission of their tumors. In a whole group 15/39 (38%) patients had breast conserving surgery (8 pre-, 7 postmenopausal, respectively), 24/39 (61%) patients radical mastectomy (13 pre-, 11 postmenopausal, respectively). In a group of patients old 40 years and younger only 2 partial resections were performed (2/9, 22%), and 7 radical mastectomies. Conclusion: Although in a small group of patients, our results confirmed that effective neo-adjuvant chemotherapy enabled breast surgery of LABC, even breast conservative procedure in some patients. However, breast conservation was not possible in majority of young patients. This suggests the investigation of more aggressive neo-adjuvant treatments, especially in patients old 40 years or younger.

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Synchronous breast and colon cancer: the importance of multidisciplinary team cancer meetings

BMJ Case Reports ◽

10.1136/bcr-2019-232680 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232680

Author(s):

Hussain Adnan Abdulla ◽

Raed Almarzooq ◽

Amal Alrayes

Keyword(s):

Colon Cancer ◽

Multidisciplinary Team ◽

Ductal Carcinoma ◽

Histopathological Examination ◽

Radical Mastectomy ◽

Right Hemicolectomy ◽

Left Breast ◽

Axillary Lymph Node Metastasis ◽

Axillary Lymph ◽

Ascending Colon

A 58-year-old female patient presented with left breast lump. Mammography and ultrasonography were performed, which reported lesions suspicious of malignancy in the left breast and axilla. Core biopsy of the lesions revealed invasive ductal carcinoma with axillary lymph node metastasis. Staging CT scan (thorax, abdomen and pelvis) identified a coexisting neoplasm in the ascending colon. Colonoscopy was performed and the tumour in the ascending colon was biopsied. Histopathological examination revealed adenocarcinoma. In the multidisciplinary team cancer meeting, it was decided to treat the breast cancer first and then the colon cancer, followed by adjuvant chemotherapy. In the first operation, left modified radical mastectomy was performed. Two weeks after her initial operation, the patient underwent laparoscopic right hemicolectomy. Postoperatively, the patient did not develop any complications and was referred to oncology for chemotherapy.

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Infiltrating ductal carcinoma of male breast: A retrospective study

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10753 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10753-10753

Author(s):

T. Puri ◽

M. Malik ◽

G. Gunabushanam ◽

D. N. Sharma ◽

P. K. Julka ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Ductal Carcinoma ◽

Lung Metastases ◽

Bilateral Breast Cancer ◽

Radical Mastectomy ◽

Male Breast ◽

Single Institution ◽

Infiltrating Ductal Carcinoma ◽

Progesterone Receptor Positivity

10753 Background: A single-institution retrospective review of the clinical presentation, treatment and outcome of male breast infiltrating ductal carcinoma (IDC). Methods: Case records of 25 male patients with a histological diagnosis of infiltrating ductal carcinoma (IDC) of breast who were treated in a single institution between 1997 to 2004 were retrospectively reviewed. Results: Patients presented at a mean age of 56 years (range, 34 to 80 years). The presenting complaint was a painless lump in the breast in all the cases. The right breast was involved in 13 cases (52%). There were no cases of bilateral breast cancer. The distribution of patients by stage at presentation are: stage IIA (24%), IIB (20%), IIIA (8%), IIIB (40%), and IV (8%). None of the patients presented with stage I disease. One patient had lung metastases at presentation. Rest of the 24 patients (96%) underwent surgery (modified radical mastectomy, 22 patients; simple mastectomy, 2 patients). Fifteen patients (60%) received adjuvant local radiotherapy. All patients received adjuvant chemotherapy: As per departmental protocol, those presenting before 2000 were treated using a regimen of Cyclophosphamide, Adriamycin and 5-Fluorouracil. After 2000, Ebirubicin was substituted for Adriamycin. Three patients were further administered Docetaxel, the indication being disease progression after first line adjuvant chemotherapy. Estrogen & Progesterone receptor positivity was 64% and 60% respectively. Hormonal therapy (Tamoxifen 14 patients, Anastrozole 2 patients) was administered in these patients. The length of follow-up from time of presentation ranged from 4 to 100 months (mean, 28 months; median, 13 months). At the time of analysis, of the 25 patients, 18 patients (72%) remain disease free, whereas 7 patients (28%) developed progressive disease. Median survival was not reached at the present time. Conclusions: Breast cancer, specifically IDC tends to present at a later stage in males, due to a lack of screening for the disease. In the present series, as a result of the advanced stage of initial presentation, all patients received adjuvant chemotherapy. There is a need to improve awareness among males, of the possibility of a painless breast lump being the first symptom of an underlying malignancy. No significant financial relationships to disclose.

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Diagnosis and treatment of chylous leakage after modified radical mastectomy for breast cancer: a case report

Journal of International Medical Research ◽

10.1177/03000605211021375 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110213

Author(s):

Yingcheng Bai ◽

Xuemei Tao ◽

Chunhong Xu ◽

Yanpeng Zhu

Keyword(s):

Breast Cancer ◽

Chest Wall ◽

Ductal Carcinoma ◽

Rare Complication ◽

Radical Mastectomy ◽

Left Breast ◽

Modified Radical Mastectomy ◽

Breast Invasive Ductal Carcinoma ◽

Chylous Leakage ◽

Meglumine Diatrizoate

The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient’s diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient's chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient's axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.

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Carcinoma en cuirasse associated to zosteriform metastasis from breast adenocarcinoma

Cancer Research and Cellular Therapeutics ◽

10.31579/2640-1053/087 ◽

2021 ◽

Vol 5 (4) ◽

pp. 01-03

Author(s):

Refka Frioui ◽

Azza Ghannem ◽

Mariam Tabka ◽

Badreddine Sriha ◽

Colandane Belajouza ◽

...

Keyword(s):

Breast Cancer ◽

Ductal Carcinoma ◽

Clinical Manifestations ◽

Left Breast ◽

Metastatic Carcinoma ◽

Breast Adenocarcinoma ◽

Wide Range ◽

History Of ◽

Original Case ◽

The Right

We report an original case of carcinoma en cuirasse associated with zosteriform metastasis. A 40-year-old woman presented to our department with painful erythematous lesions. She had a history of invasive ductal carcinoma of the left breast. Numerous erythematous, papules and whitish vesicles were present over the right side of the chest in a dermatomal distribution with indurated coalescent plaques. Biopsy revealed metastatic carcinoma of breast origin. Breast mammography showed suspicious right nodule. Controlateral breast carcinoma with CM was diagnosed. CM show a wide range of clinical manifestations. Carcinoma en cuirasse, is a very rare form of metastatic cutaneous breast cancer. It is characterized by diffuse sclerodermatous induration of the skin. Zosteriform metastasis is also rarely seen. It may be distributed along dermatomeres in a variety of clinical patterns, including nodular, papulovesicular, or vesiculobullous. In our case, the zosteriform metastasis occurred in the contralateral site. It announced the developing of contralateral breast cancer.

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Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome

International Surgery Journal ◽

10.18203/2349-2902.isj20200309 ◽

2020 ◽

Vol 7 (2) ◽

pp. 526

Author(s):

Dakshayani S. Nirhale ◽

Rizhin Sooraj ◽

Anshu Rawat

Keyword(s):

Breast Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Ductal Carcinoma ◽

Locally Advanced Breast Cancer ◽

Clinical Stage ◽

Locally Advanced ◽

Radical Mastectomy ◽

Conservative Surgery ◽

Advanced Breast ◽

Number Of Patients

Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase the chance of recurrence in the follow up period.

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