Fat-enlarged axillary lymph nodes are associated with node-positive breast cancer in obese patients

Purpose Obesity associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer. Methods This retrospective case–control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-treatment and pre-operative breast MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion. Results A strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting axillary metastasis, and this increased to 0.77 when combined with patient and tumor characteristics. Conclusion Fat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

Fat-enlarged Axillary Lymph Nodes are Associated with Node-Positive Breast Cancer in Obese Patients

PurposeObesity-associated fat infiltration of organ systems is accompanied by organ dysfunction and poor cancer outcomes. Obese women demonstrate variable degrees of fat infiltration of axillary lymph nodes (LNs), and they are at increased risk for node-positive breast cancer. However, the relationship between enlarged axillary nodes and axillary metastases has not been investigated. The purpose of this study is to evaluate the association between axillary metastases and fat-enlarged axillary nodes visualized on mammograms and breast MRI in obese women with a diagnosis of invasive breast cancer.MethodsThis retrospective case-control study included 431 patients with histologically confirmed invasive breast cancer. The primary analysis of this study included 306 patients with pre-operative MRI and body mass index (BMI) > 30 (201 node-positive cases and 105 randomly selected node-negative controls) diagnosed with invasive breast cancer diagnosed between April 1, 2011, and March 1, 2020. The largest visible LN was measured in the axilla contralateral to the known breast cancer on breast MRI. Multivariate logistic regression models were used to assess the association between node-positive status and LN size adjusting for age, BMI, tumor size, tumor grade, tumor subtype, and lymphovascular invasion.ResultsA strong likelihood of node-positive breast cancer was observed among obese women with fat-expanded lymph nodes (adjusted OR for the 4th vs. 1st quartile for contralateral LN size on MRI: 9.70; 95% CI: 4.26, 23.50; p < 0.001). The receiver operating characteristic curve for size of fat-enlarged nodes in the contralateral axilla identified on breast MRI had an area under the curve of 0.72 for predicting node-positive breast cancer and this increased to 0.80 when combined with patient and tumor characteristics.ConclusionFat expansion of axillary lymph nodes was associated with a high likelihood of axillary metastases in obese women with invasive breast cancer independent of BMI and tumor characteristics.

Recurrent follicular thyroid carcinoma metastatic to axillary lymph nodes mimicking pulmonary adenocarcinoma

Differentiated thyroid cancers generally have favorable prognoses, though follicular thyroid cancer is overall associated with a worse prognosis due in part to increased incidence of distant metastasis. We report a case of a 51-year-old woman with a history of widely invasive follicular thyroid carcinoma treated with a total thyroidectomy, radioactive iodine and external beam radiation. Five and a half years following her surgery, she was found to have an axillary lymph node mass, multiple lung masses, and a hilar mass in the setting of declining thyroglobulin (Tg) antibodies. Her metastases were initially thought to be due to a primary lung adenocarcinoma given a neoplastic cell immunophenotype that included an absence of Tg expression and co-expression of TTF-1 and Napsin A. However, PAX8 expression demonstrated that the axillary and hilar metastases were actually thyroid in origin rather than lung. Axillary metastases in differentiated thyroid carcinoma are exceedingly rare and previous reports have typically involved widely disseminated disease with extensive neck lymphadenopathy. With a decline in Tg antibodies levels in high-risk patients, one should consider progression and loss of differentiation of thyroid carcinoma rather than a response to treatment. Learning points Axillary metastases in differentiated thyroid carcinoma are uncommon. In patients with high-risk thyroid carcinomas, a decline in thyroglobulin antibody may not signal disease improvement, but rather a progression to a poorly differentiated form of cancer. PAX8 staining can be used to differentiate thyroid carcinomas from lung adenocarcinomas.

Analyzing non-sentinel axillary metastases in patients with T3–T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy

Purpose In the ACOSOG Z0011 trial, completing axillary lymph node dissection (cALND) did not benefit patients with T1–T2 cN0 early breast cancer and 1–2 positive sentinel lymph nodes (SLN) undergoing breast-conserving surgery (BCT). This paper reports cALND rates in the clinical routine for patients who had higher (T3–T4) tumor stages and/or underwent mastectomy but otherwise met the ACOSOG Z0011 eligibility criteria. Aim of this study is to determine cALND time trends and non-sentinel axillary metastases (NSAM) rates to estimate occult axillary tumor burden. Methods Data were included from patients treated in 179 German breast cancer centers between 2008 and 2015. Time-trend rates were analyzed for cALND of patients with T3–T4 tumors separated for BCT and mastectomy and regarding presence of axillary macrometastases or micrometastases. Results Data were available for 188,909 patients, of whom 19,009 were identified with 1–2 positive SLN. Those 19,009 patients were separated into 4 cohorts: (1) Patients with T1–T2 tumors receiving BCT (ACOSOG Z0011 eligible; n = 13,741), (2) T1–T2 with mastectomy (n = 4093), (3) T3–T4 with BCT (n = 269), (4) T3–T4 with mastectomy (n = 906). Among patients with T3–T4 tumors, cALND rates declined from 2008 to 2015: from 88.2 to 62.6% for patients receiving mastectomy and from 96.6 to 58.1% in patients receiving BCT. Overall rates for any NSAM after cALND for cohorts 1–4 were 33.4%, 42.3%, 46.9%, 58.8%, respectively. Conclusions The cALND rates have decreased substantially in routine care in patients with ‘extended’ ACOSOG Z0011 eligibility criteria. Axillary tumor burden is higher in these patients than in the ACOSOG Z0011 trial.

Comparative analysis of the receptor status of the primary focus and synchronous axillary metastases in breast cancer patients

The aim of the investigation. To study concordance of surrogate molecular subtype in the pairs of primary and synchronous axillary metastases in patients with invasive breast cancer (IBC). Materials and methods. Retrospective analysis included 80 patients aged 28 to 90 years (average age 40.35.3 years) with a first-time diagnosed IBC who underwent surgical treatment at the N.N. Blokhin National Medical Research Center of Oncology during 20162018 years. None of the patients received any neoadjuvant drug therapy. The pathological evaluation of the estrogen receptors (ER), progesterone receptor (PR), HER2 expression and estimation of proliferative activity (Ki-67 index) with subsequent assignment to surrogate subtypes were performed according to ASCO/CAP protocols and the recommendations of the 20132019 San-Gallen Conference on treatment of Early Breast Cancer. Results. Preliminary results of our study revealed therapeutically significant changes in hormone receptor status, HER2-status and proliferative activity in 12.5% of cases of Luminal A type IBC, 20% of Luminal B/HER2-positive and 4% of Luminal B/Her2-negative subtypes of IBC.

Encapsulated papillary carcinoma concomitant with axillary metastasis of neuroendocrine carcinoma – case report

Introduction: Encapsulated papillary carcinoma corresponds to approximately 1% of breast tumors. Although rare, it has a good prognosis, slow growth, and a 10-year survival close to 100%. Axillary metastases of non-breast neoplasms are also uncommon, and the coexistence of metastatic non-breast neoplasm in the axilla and another histological type of breast neoplasm is exceedingly rare. Objective: To describe a case of breast neoplasm with axillary metastasis of non-breast disease. Method/Case report: F.R., 95 years old, had a nodule in the left breast (LB) for 1 year, with progressive growth. Examination revealed an irregular nodule in the entire LB with retraction of the papilla, measuring 11x12 cm, and hardened lymphadenopathy of 2 cm in the right axilla. Ultrasound showed a mixed tumor with a multinodular central mass of 18.3x19.7 cm and two enlarged, heterogeneous lymph nodes in the right axilla. Core breast biopsy indicated carcinoma with a papillary growth pattern. She underwent left mastectomy and lymph node excision in the right axilla. Anatomopathological results revealed a 14 cm encapsulated papillary carcinoma with free margins and right axillary lymph node as a high-grade metastatic neuroendocrine carcinoma. She is on exclusive hormone therapy with tamoxifen. When investigating the primary axillary site, abdominal computed tomography (CT) showed an expansive, predominantly cystic, retroperitoneal formation on the left side, in close contact with the tail of the pancreas, adrenal gland, and left renal vein, pending clarification, probably related to the right axillary lesion. Due to clinical conditions, she continues without a diagnosis for the primary site of axillary metastasis. Results/Discussion: Encapsulated papillary carcinoma is characterized by being solitary, unilateral, of slow growth, with papillary proliferation, central malignancy, surrounded by cystic ductal dilatation. It has a good prognosis and is rarely metastatic. Usually, it presents low or intermediate nuclear grade and strong positivity for estrogen receptor. Neuroendocrine tumors are a relatively rare group of neoplasms in any part of the body, occurring in the digestive tract in 62%–82% of cases. They can be asymptomatic or have symptoms associated with the primary tumor or metastasis. They are a heterogeneous group, often found in the retroperitoneum, abdominal lymph nodes, and mediastinum, usually have multiple metastases, and their primary site is hard to identify. Axillary metastases are uncommon, mainly coexisting with breast neoplasm of good prognosis. Conclusion: The rarity of axillary metastasis of neuroendocrine carcinoma associated with the good prognosis of encapsulated papillary carcinomas gives scientific importance to the current case since its axillary approach allowed reaching an unlikely diagnosis of neoplasm with uncommon metastatic site.