A Case of Secretory Carcinoma in a Patient With a History of Contralateral Medullary Carcinoma

Background: Secretory and medullary carcinomas of the breast are rare subtypes of infiltrating ductal carcinoma. The different histological behavior of medullary and secretory carcinomas is correlated with different imaging features on mammography, ultrasound, and magnetic resonance imaging. Case Report: We report the case of a Caucasian woman in which both subtypes of tumors were diagnosed in an 8-year time interval and evaluate, in antithesis, histopathological and imaging aspects of medullary and secretory carcinoma. Conclusion: To our knowledge, this is the first case reported in literature of secretory carcinoma with a complete imaging tumor evaluation in a patient with a previous contralateral medullary cancer.

Correlation of DCE-MRI Perfusion Parameters and Molecular Biology of Breast Infiltrating Ductal Carcinoma

ObjectiveWe aimed to investigate the correlation of the perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with the molecular biological expression of breast infiltrating ductal carcinoma (IDC) in order to guide appropriate therapeutic advice and clinical outcome prediction.Materials and MethodsIn a prospective analysis of 67 patients with breast IDC, preoperative DCE-MRI and routine MRI images were obtained. The double-chamber model (extended Tofts model) was employed to calculate the perfusion parameters. Postoperative pathological immunohistochemistry was examined, including human epidermal growth factor receptor 2 (HER-2), estrogen receptor (ER), progesterone receptor (PR), cell nuclear-associated antigen (Ki-67), cytokeratin 5/6 (CK5/6), and epidermal growth factor receptor (EGFR). Statistical analysis was applied to explore the relationship between the perfusion parameters and the molecular biomarkers of breast cancer.ResultsA total of 67 lesions were included in our study. The mean maximum diameter of lesions was 4.48 ± 1.73 cm. Perfusion parameters had no correlation with tumor diameters (p > 0.05). The volume transfer constant (Ktrans) and the rate constant (kep) had positive correlations with Ki-67 (p < 0.05). The plasma volume ratio (vp) had a statistical difference between CK5/6 positivity and CK5/6 negativity. The maximum rising slope (MAX Slope) was higher in HER-2-enriched tumors than that in luminal A or B tumors (p < 0.05). kep was higher in HER-2-enriched tumors than that in luminal A tumors (p < 0.05). The extravascular extracellular space volume fraction (ve) was higher in triple-negative tumors than that in HER-2-enriched and in luminal A and B tumors (p < 0.05). The time to peak enhancement (TTP) was lower in HER-2-enriched tumors than that in luminal A and B tumors (p < 0.05). Maximum concentration (MAX Conc) was higher in triple-negative tumors than that in luminal B tumors (p < 0.05).ConclusionDCE-MRI perfusion parameters can behave as a noninvasive tool to assess the molecular biological expression and the molecular subtypes of breast IDC. They may aid in predicting breast IDC invasiveness, metastasis, and prognosis.

The Efficacy of Physical Therapy Rehabilitation Program for Women Following a Modified Radical Mastectomy: A Case Report

Background: The most commonly identified cancer is breast cancer. In either the lobules or the breast ducts, the cancer normally grows. Infiltrating ductal carcinoma is the most common subtype. It may appear as a lump or mass; changes in the skin or nipple; breast rash or redness; or lymphadenopathy. Presenting Complains and Investigations: the patient presented with the complains of swelling and pain in the left breast in lower outer quadrant since 6 months, which was initially small in size and gradually increased and reached up this level 2x2 cm which placed in infra areolar region covering lower inner and outer quadrant. USG and cytology reports showed bilateral breast with axilla. Right breast was normal, enlarged lymph node in the right axilla measuring 15.2 x 4.6 mm with maintained hilum S/O reactive lymphadenopathy. In left breast there is E/O ill-defined taller than wider irregular hypoechoic lesion with spiculated margins, measuring approximately 15.9 x 12.4 mm in lower inner quadrant containing multiple foci of calcification within showing central vascularity OB doppler on elastography lesion is stiff, in left axilla there is E/O on enlarged USG lymph node present measuring 10.2 x 6.7 mm with maintained hilum S/O reactive lymphadenopathy. Impression of F/S/O malignant lesion in the left breast lymphadenopathy. Diagnosis: Left sided infiltrating ductal carcinoma. Therapeutic Intervention and Outcomes: Physical therapy intervention involved a variety of range of motion exercises, strengthening exercises, resistance conditioning, breathing exercises, lymphoedema treatment and scar management. This intensive outpatient program is a successful way to enhance the mobility of the shoulder and ROM during the initial 6-week treatment cycle after surgery. Shoulder range of motion was increased, patient was able to do basic activities of daily living like dressing, bathing, combing, etc. Edema was reduced. Conclusion: Shoulder stiffness after modified radical mastectomy is the commonest complication. Upper limb mobility exercises reduced the shoulder stiffness. Breathing exercises improved the respiration. Strengthening and general aerobic exercises helped the patient to get back on her normal routine.

P–465 Effect of letrozole over Ki–67 expression in breast cancer during controlled ovarian stimulation (COS) for fertility preservation (FP): case report

Study question Does concomitant letrozole administration during COS alter Ki–67 expression in women undergoing FP procedures before breast cancer surgery? Summary answer Concomitant letrozole administration during COS, even for a short period, can reduce Ki–67 expression in breast cancer. What is known already The biggest concern with COS in breast cancer patients is the increase in serum estradiol levels, caused by the development of multiple follicles simultaneously. This has always been a major hindrance to the use of traditional ovarian stimulation regimens in these patients, due to the large amount of evidence on the pathogenetic role of estrogen in breast cancer propagation. To limit the rise of estradiol during COS, most centers have adopted concomitant letrozole administration. Recently, some studies have reported changes in tumor pathology after letrozole administration, such as a significant fall in Ki–67 expression. Study design, size, duration Case report including 2 patients undergoing COS with concomitant letrozole administration for 12 days before breast cancer surgery. Participants/materials, setting, methods The first patient was a 28-year-old Caucasian woman with a breast biopsy showing an infiltrating ductal carcinoma in the upper external quadrant of the right breast. The second patient was a 33-year-old Caucasian woman with a diagnosis of infiltrating ductal carcinoma of the upper external quadrant of the left breast. Both patients underwent COS with concomitant letrozole administration 5 mg daily for 12 days. Ovarian stimulation was performed using a GnRH-antagonist random-start protocol. Main results and the role of chance In the first patient, Ki–67 expression in the initial biopsy was 55%. After completion of FP procedures, she underwent quadrantectomy with sentinel-lymphnode biopsy. In the final histopathological report Ki–67 expression fell to 25%. In the second patient, the first biopsy showed a Ki–67 expression of 30%, while after mastectomy it fell to 10%. Limitations, reasons for caution Only 2 patients were included in the study. Wider implications of the findings: COS is feasible before breast cancer surgery, as long as an adequate cancer biopsy with immunohistochemical evaluation has been collected. Cytological diagnosis is not enough to start FP procedures. Evaluation of biological parameters after letrozole administration could lead to underestimation of cancer proliferation rate and to inappropriate treatment strategies. Trial registration number NA

Expression of PDL-1 and Its Correlation with TIL in Triple Negative Cases of Breast Carcinoma

Background: In the present study, we aimed to determine the expression of PDL1 and its correlation with TIL in Triple Negative (ER, PR and Her 2neu negative) cases of breast carcinoma (immune-histochemical study) Methods: Expression of PD-L1 was seen on 40 proven triple negative cases of breast carcinomas (TNBC) and to correlate it with other parameters affecting prognosis of the disease. All the cases were infiltrating ductal carcinoma NOS (not otherwise specified) Result: Maximum cases were Grade III (67.5%) followed by Grade II (32.5%). PD-L1 positivity was seen in 32.5% cases whereas TIL was positive for PD-L1 in 27.5 %. 5 cases were positive for both epithelial cell and TIL. Out of 13 PD-L1 positive tumors, 38.5% cases showed TIL positivity whereas out of 27 PD-L1 negative tumors, only 22.2% were TIL positive. PD-L1 expression in TIL was seen in 38.5% of cases however there was no statistically significant correlation between PD-L1 positivity and TIL positivity. PDL-1 positivity was more in Grade III (33.3%) as compared to Grade II (23%) lesions. Thus, it was observed that PD-L1 positivity increased from grade II to grade III lesions. Conclusion: Intra-tumoral expression of PD-L1 is directly proportional to histological grade, aggressive subtypes in TNBC cases however there was no statistically significant correlation between PD-L1 positivity in tumor cells and TIL positivity. We thus postulate that measurement of PD-L1 expression in TNBC cases could enhance the accuracy of predicting patient prognosis and allow for optimal treatment selection.

The clinical features and prognosis of patients with mucinous breast carcinoma compared with those with infiltrating ductal carcinoma: a population-based study

Background At present, the characteristics of mucinous breast carcinoma (MBC) and the factors affecting its prognosis are controversial. We compared the clinical features of MBC with those of infiltrating ductal carcinoma (IDC) and summarized the relevant prognostic factors. Methods The Surveillance, Epidemiology, and End Results (SEER) database includes information on 10,593 patients diagnosed with MBC between 2004 and 2016. Chi-square tests and analyses were used to analyze differences in variables between the MBC and IDC groups. Univariate and multivariate Cox proportional hazards models were used to assess the relative impacts of risk factors on cancer-specific survival (CSS) in patients. Kaplan-Meier survival curves were constructed to assess cancer-specific mortality and were compared using the log-rank test. Results From 2004 to 2016, 10,593 people were diagnosed with MBC, and 402,797 were diagnosed with IDC. Patients with MBC had significantly higher 5−/10-year CSS rates (96.4%/93.4%) than those with IDC (89%/83.8%). Compared with IDC patients, MBC patients had less lymph node metastasis, an earlier stage, a higher rate of hormone receptor positivity and a lower expression rate of HER2. Univariate and multivariate analyses showed that age ≥ 60 years old (HR = 1.574, 95%CI: 1.238–2.001, P < 0.001), singled status (HR = 1.676, 95%CI: 1.330–2.112, P < 0.001) and advanced TNM/SEER stage were independent prognostic risk factors for MBC. In addition, positive estrogen receptor (HR = 0.577, 95%CI: 0.334–0.997, P = 0.049), positive progesterone receptor (HR = 0.740, 95%CI: 0.552–0.992, P = 0.044), surgical treatment (HR = 0.395, 95%CI: 0.288–0.542, P < 0.001) and radiotherapy (HR = 0.589, 95%CI: 0.459–0.756, P < 0.001) were identified as protective factors. Conclusion Compared with IDC, MBC has a better prognosis. For patients with MBC, we identified prognostic factors that can help clinicians better assess patient outcomes and guide individualized treatment.

A Study of Patterns of Breast Lesions Diagnosed on Fine-Needle Aspiration Cytology in a Tertiary Care Hospital of Mandya

BACKGROUND Breast lump is fairly a common complaint in females for which patient seeks medical advice and becomes anxious about the diagnosis. Quick diagnosis by fineneedle aspiration cytology (FNAC) relieves patient’s anxiety and assists in their preoperative management and overall treatment. This study was conducted to find out the cytomorphological patterns and distribution of breast lesions in various age groups in our institute. METHODS This is a prospective observational study of breast lesions conducted in the Mandya Institute of Medical Sciences, Mandya, for a period of 18 months from January 2016 to June 2017. About 200 cases were studied by cytology and correlated with histopathology wherever biopsy specimens were available, and were stained with haematoxylin and eosin (H & E) and May–Grunwald–Giemsa stains (MGG). Cases were grouped according to the five-tier reporting format for breast lesion (C1 – C5) laid down by National Cancer Institute. RESULTS The spectrum of breast lesions on cytomorphological interpretation was 1 % inadequate / insufficient material (C1), 80 % benign (C2), 1.5 % atypia probably benign (C3), 0.5 % suspicious of malignancy (C4) and 17 % malignant (C5). Out of 200 cases studied, 160 cases were benign lesions, and 34 cases were malignant lesions. Most of the benign lesions belonged to the age group 21 - 30 years followed by 31 - 40 years. Malignant lesions were maximum in the age group of 41 - 50 years. In benign disease, fibroadenoma was the commonest i.e. (31 %) followed by fibrocystic change (22 %), benign epithelial hyperplasia (8.7 %), acute mastitis (3 %), chronic mastitis (2 %), epidermal cyst (1.8 %), subareolar abscess, granulomatous mastitis, galactocele (1 %) and gynaecomastia (8.5 %). In the malignant group, infiltrating ductal carcinoma - not otherwise specified, was the commonest lesion (82.4 %), followed by mucinous carcinoma (8.8 %), papillary carcinoma, medullary carcinoma and metaplastic carcinoma (2.9 %). In this study, the specificity, sensitivity, positive and negative predictive value, and diagnostic accuracy of fine-needle aspiration cytology were 100 %, 90 %, 100 %, 95 %, and 96 %, respectively. CONCLUSIONS FNAC of the breast lump is an easily performed outpatient diagnostic method for determining the nature of the breast mass. KEYWORDS FNAC, Fibroadenoma, Haematoxylin and Eosin, Infiltrating Ductal Carcinoma - Not Otherwise Specified (IDC NOS), May Grunwald Giemsa

Correlation of HER-2/neu Status with Estrogen (ER) & Progesterone (PR) Receptor in Breast Malignancies

Introduction: Prognosis and management of breast cancer are influenced by the classic variables such as histologic type and grade, tumor size, lymph node status, status of hormonal receptors- i.e. estrogen receptor (ER) and progesterone receptor (PR) of the tumor, and, more recently, HER-2/neu (Human Epidermal Growth factor Receptor-2) overexpression. Expression levels of the estrogen, progesterone and HER2/neu receptors which characterize clinically distinct breast tumours have been shown to change during disease progression and in response to systemic therapies. The interrelationship of ER, PR, and HER -2 has come to have a crucial role in the management of breast cancer. Aims & Objectives: To determine the ER, PR and HER2/neu status in breast malignancies. Place and duration of study: The study was conducted at Department of Histopathology, Federal Postgraduate Medical Institute, Shaikh Zayed Hospital Lahore, for the period of Six months. Material & Methods: 30 samples of diagnosed breast cancer were included in study. Formalin fixed paraffin embedded wax block were taken for immunohistochemical staining of ER, PR & HER-2/neu. Results: Out of 30 cases, racially 29 were Punjabi and 1 was Pakhtun. There were 23 mastectomy samples and 7 needle core biopsies. Out of 30 cases, 29 were Infiltrating Ductal Carcinoma. Grade I, II, III 13.3%, 66. 7% and 20% respectively and only one case was of Carcinosarcoma (p<0.01). Overall immunoexpression for ER, PR and HER-2/neu were 33.3% (p<0.01), 56.7% (p<0.05) and 73.3% respectively. Triple positive (TP) cases were 23.3% and triple negative (TN) were 10 %. Regarding ER expression in infiltrating ductal carcinoma, 63.3% were ER negative and 33.3% were ER positive and comparison was statistically highly significant (p<0.01) .PR expression in infiltrating ductal carcinoma showed 56.7% PR positive and 40% PR negative which was statistically significant (p<0.05).There is negative correlation of HER-2/neu positive and ER positive and positive correlation of HER-2/neu positive and PR positive cases. Conclusion: There is inverse correlation of HER-2/neu positive and ER positive and positive correlation of HER-2/neu positive and PR positive cases.

Acute Adrenal Insufficiency in a Patient with Metastatic Infiltrating Ductal Carcinoma

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