Bilateral Neuroendocrine Carcinoma of Breast: A Case Report

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.

Association Between Monocyte Levels and Breast Lump Detected By Ultrasound Among Chinese Women: A Longitudinal Study

Background Few studies have focused on the relationship between monocyte and breast lump. To explore whether absolute monocyte count (AMC) or monocyte percent (%MONO) could be used as a new circulation tumor marker for breast lump detection by ultrasonography among Chinese women. Methods A total of 3,231 women who had at least two breast ultrasonography examinations were followed up from January 2014 to December 2019. Adjusted Cox proportional hazards regression models were used to evaluate the relationships between AMC and %MONO and the incidence of breast lump. Results During a total of 6,037 person-years of follow-up, 803 participants developed a breast lump. In the final multivariable adjusted models, using the lowest quartile as the reference group, the HRs (95%CIs) of breast lump were 1.18 (0.95, 1.45), 1.33 (1.08, 1.65), and 1.28 (1.02, 1.61), respectively, for AMC in the 2nd, 3rd, and 4th quartiles (Ptrend < 0.001). The corresponding HRs (95%CIs) for %MONO in the 2nd, 3rd, and 4th quartiles were 1.03 (0.83, 1.28), 1.28 (1.03, 1.29), and 1.62 (1.30, 2.02, Ptrend< 0.001), respectively. The multivariable adjusted HRs for breast lump per unit increase of AMC and %MONO were 3.19 (1.38, 7.38; P = 0.007) and 1.14 (1.08, 1.21; P < 0.001), respectively. The effect of high monocyte levels on increased risks of breast lump were more remarkable in younger women. Conclusion This study demonstrated that increased monocyte levels can be used as an indicator of the incidence of breast lump, especially for younger women.

Atypical sonographic presentation of diabetic mastopathy: A case report and literature review

Diabetic fibrous mastopathy (DFM) is a relatively rare condition that most often occurs in insulin-dependent diabetics with a characteristic hypoechoic appearance on ultrasound (US). DFM frequently poses a diagnostic challenge in radiology due to malignant imaging similarities, and core needle biopsy is often required. If DFM is in the differential, fine-needle aspiration should not be considered as it will likely be non-diagnostic due to insufficient sampling and excisional biopsy should be avoided as it may worsen the disease process. Therefore, high clinical suspicion of DFM is important for diagnostic intervention consideration. We report the case of a 57-year-old who presented with a firm breast lump which on mammography was seen as a new 5.8 by 5.3 cm global asymmetry. US was performed and a diffuse area of increased echogenicity without posterior shadowing was identified. Given the appearance and patient history, DFM was considered unlikely. However, core needle biopsy revealed diabetic lymphocytic mastopathy consistent with DFM. Even though DFM is uncommon and has been reported to have a specific US appearance, it should be included in the differential for a palpable breast lump in any diabetic patient regardless of glucose control or atypical imaging findings.

A Low-cost model of breast biopsy for the training of surgical residents during COVID-19 pandemic

We describe a low-cost simulation model for teaching core needle biopsy to surgical trainees in Low- and Middle-income countries (LMICs). Pre-session and post-session surveys showed that correct core sampling (ability to hit the beetroot) after training was 91.4% compared to 75.7% before demonstration and improved adequacy (68.5% before v. 85.7% after). This low-cost model using locally available products is designed to simulate a palpable breast lump and can easily be incorporated into surgical training in LMICs, where a palpable breast lump is the commonest presentation of breast cancer.

Breast surgery

This chapter outlines the surgical and medical treatment of breast cancer in females and males, breast cancer screening, benign breast conditions, breast pain and gynaecomastia. It describes the assessment of a breast lump with triple assessment and also how to perform a punch biopsy.

Assessment of clinical significance of serum uric acid, serum bilirubin and serum creatinine in patients with breast lump

Background: Breast cancer is the most common cancer in females, approximately a quarter of all cancers. Several tumor markers are being studied now a days like α feto protein, carcinoembryonic antigen, and human chorionic gonadotropin but, the cost of these analytical methods is very high. This study is directed to assess prognostic value of serum uric acid, serum bilirubin and serum creatinine in breast lump cases. And to compare variation in benign and malignant breast lumps in relation to serum uric acid, serum bilirubin and serum creatinine values.Methods: Observational and prospective study conducted in Hamidia Hospital, Bhopal from November 2018-July 2020 included 100 patients. 50 patients were having benign breast lumps and other 50 patients malignant. Categorization of the patients done on the basis of histopathological examination. Autoanalyzer was used for estimation of serum uric acid, serum bilirubin and serum creatinine.Results: High serum uric acid level may anticipate poor prognosis in carcinoma breast, and it may perform a promising role in the management of the same. The level of serum bilirubin was slightly more or within normal range. The level of serum creatinine was within normal range in absence of any renal impairment by other etiology.Conclusions: The evaluation of serum uric acid and serum bilirubin may be useful for predicting prognosis in females with malignant breast lump and can provide help in making diagnosis during the initial assessment of the patient presenting with breast lump.

Spindle Cell Metaplastic Breast Carcinoma

Introduction: Metaplastic breast carcinoma is an uncommon malignancy that constitutes < 5% of all breast cancers. There are 5 subtypes which are spindle cell, squamous cell, carcinosarcoma, matrix-producing and metaplastic with osteoclastic giant cells. Spindle cell carcinoma represents approximately <0.3% of invasive breast carcinomas. It is typically a triple-negative cancer with distinct pathological characteristics, but relatively a non-conclusive imaging findings. Case report: An elderly lady presented with an enlarging painful left breast lump for 1 year. Palpable left breast lump noted on clinical examination. Mammography demonstrated a high density, oval lesion with a partially indistinct margin. Corresponding ultrasound showed a large irregular heterogeneous lesion with solid-cystic areas. Histopathology showed atypical spindle-shaped cells which stained positive for cytokeratins and negative for hormone and human epidermal growth factor receptors, which favours spindle cell metaplastic carcinoma. Left mastectomy and axillary dissection were performed, and the final diagnosis was consistent with metaplastic spindle cell carcinoma. Conclusion: Spindle cell carcinoma of the breast is a rare aggressive histological type of carcinoma which may present with benign features on imaging. Tissue diagnosis is essential for prompt diagnosis with multidisciplinary team discussion to guide management and improve patient’s outcome.

Concordance with urgent referral guidelines in patients presenting with any of six ‘alarm’ features of possible cancer: a retrospective cohort study using linked primary care records

BackgroundClinical guidelines advise GPs in England which patients warrant an urgent referral for suspected cancer. This study assessed how often GPs follow the guidelines, whether certain patients are less likely to be referred, and how many patients were diagnosed with cancer within 1 year of non-referral.MethodsWe used linked primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and cancer registration data. Patients presenting with haematuria, breast lump, dysphagia, iron-deficiency anaemia, post-menopausal or rectal bleeding for the first time during 2014–2015 were included (for ages where guidelines recommend urgent referral). Logistic regression was used to investigate whether receiving a referral was associated with feature type and patient characteristics. Cancer incidence (based on recorded diagnoses in cancer registry data within 1 year of presentation) was compared between those receiving and those not receiving referrals.Results48 715 patients were included, of which 40% (n=19 670) received an urgent referral within 14 days of presentation, varying by feature from 17% (dysphagia) to 68% (breast lump). Young patients (18–24 vs 55–64 years; adjusted OR 0.20, 95% CI 0.10 to 0.42, p<0.001) and those with comorbidities (4 vs 0 comorbidities; adjusted OR 0.87, 95% CI 0.80 to 0.94, p<0.001) were less likely to receive a referral. Associations between patient characteristics and referrals differed across features: among patients presenting with anaemia, breast lump or haematuria, those with multi-morbidity, and additionally for breast lump, more deprived patients were less likely to receive a referral. Of 29 045 patients not receiving a referral, 3.6% (1047) were diagnosed with cancer within 1 year, ranging from 2.8% for rectal bleeding to 9.5% for anaemia.ConclusionsGuideline recommendations for action are not followed for the majority of patients presenting with common possible cancer features. A significant number of these patients developed cancer within 1 year of their consultation, indicating scope for improvement in the diagnostic process.

EP.TH.664Breast lump recurrence - malignancy or iatrogenic disease process?

Backgound Fibromatosis is a rare disease, accounting for 0.2% of breast tumours and 3% of soft tissue tumours. Due to its rarity there is a lack of multi centre trials and therefore evidence and guidance on the best treatment options. Likewise, many clinicians are unfamiliar with how to best manage these patients, even in specialist centres. Methods We present the case of a patient presenting with a suspicious breast lump, diagnosed as fibromatosis. Literature search enabled review of current trends and opinions in the management of such patients. Results We discuss the case of a 70 year old patient with a right breast lump, presenting 3 years following wide local excision and radiotherapy for DCIS. Imaging and examination were suspicious for malignancy. Biopsy demonstrated fibromatosis, for which the patient is currently being managed with active observation. Discussion and Conclusion Desmoid tumours of the breast are a rare but important differential in patients presenting with a breast lump. The aetiology remains poorly understood but they have been linked to genetic conditions, and trauma. As with this case, trauma may be iatrogenic in the form of surgery or radiotherapy. Due to the destructive nature of fibromatosis, the current trend in the management of these patients advocates wide local excision where possible. However, there is a high recurrence rate. There has been some success with medical therapies such as NSAIDs and tyrosine kinase inhibitors. These may be viable options in patients in whom surgery is not suitable.