Radiation-Associated Primary Osteosarcoma of the Breast

Pathobiology ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 322-326
Author(s):  
Helen Bartlett ◽  
Maiar Elghobashy ◽  
Nayneeta Deshmukh ◽  
Rashmi Rao ◽  
Abeer M. Shaaban
Keyword(s):  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Metaplastic Carcinoma ◽  
Post Irradiation ◽  
In Situ Carcinoma ◽  
Complete Surgical Excision ◽  
Spindle Cell Lesion ◽  
Phyllodes Tumour

<b><i>Introduction:</i></b> Non-epithelial primary mammary osteosarcomas are extremely rare. The differentials include metaplastic carcinoma and malignant phyllodes tumour. This is the first published case of primary breast osteosarcoma arising after local radiotherapy. <b><i>Case Presentation:</i></b> A 73-year-old female presented with a right-sided breast lump. The same breast had been irradiated 11 years previously for invasive ductal carcinoma. Diagnostic excision revealed a highly cellular, malignant spindle-cell lesion merged with an osteoid matrix and foci of calcification and bone formation. Immunohistochemistry and molecular studies showed no lines of differentiation. Due to the lack of epithelial/glandular differentiation, in situ carcinoma or leaf-like pattern, the diagnosis of post-irradiation osteosarcoma was made. She underwent mastectomy and is disease-free at 8 months of follow-up. <b><i>Conclusion:</i></b> Post-irradiation osteosarcoma should be considered in the differential diagnosis of breast lesions showing malignant osteoid. Extensive sampling and careful search for epithelial differentiation is required to guide management. Complete surgical excision is recommended.

scholarly journals High-grade ductal carcinoma in-situ detected by microcalcification within borderline phyllodes tumour: A report of a case and literature review

2021 ◽  
Author(s):  
Wing Nam Yuen ◽  
Joshua Jing Xi Li ◽  
Man Yi Chan ◽  
Gary M Tse
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Management Plan ◽  
High Grade ◽  
Total Mastectomy ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Abstract BackgroundPhyllodes tumour is a rare biphasic neoplasm of the breast that mostly affects middle aged women. Ductal carcinoma in-situ and microcalcifications occurring within phyllodes tumours are documented but are rare findings. Primary surgical excision with adjuvant therapies remains the mainstay of treatment.Case presentationWe report a case of a 42-year-old woman with high-grade ductal carcinoma in-situ within a borderline phyllodes tumour. Radiologically, clumps of microcalcification were detected within the lesion. Local excision followed by total mastectomy with axillary dissection was then performed. No tumour recurrence was detected up to a period of 8 years.ConclusionPresence of microcalcifications within a phyllodes tumour should alert clinicians and pathologists of possible coexisting carcinoma components. Stromal and epithelial components of these lesions should be evaluated separately when formulating a management plan.

scholarly journals Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study

2015 ◽  
Vol 33 (33) ◽  
pp. 3938-3944 ◽  
Author(s):  
Lawrence J. Solin ◽  
Robert Gray ◽  
Lorie L. Hughes ◽  
William C. Wood ◽  
Mary Ann Lowen ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Tumor Size ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Multivariable Analysis ◽  
Treatment Decision ◽  
Surgical Excision ◽  
Study Cohort

Purpose To determine the 12-year risk of developing an ipsilateral breast event (IBE) for women with ductal carcinoma in situ (DCIS) of the breast treated with surgical excision (lumpectomy) without radiation. Patients and Methods A prospective clinical trial was performed for women with DCIS who were selected for low-risk clinical and pathologic characteristics. Patients were enrolled onto one of two study cohorts (not randomly assigned): cohort 1: low- or intermediate-grade DCIS, tumor size 2.5 cm or smaller (n = 561); or cohort 2: high-grade DCIS, tumor size 1 cm or smaller (n = 104). Protocol specifications included excision of the DCIS tumor with a minimum negative margin width of at least 3 mm. Tamoxifen (not randomly assigned) was given to 30% of the patients. An IBE was defined as local recurrence of DCIS or invasive carcinoma in the treated breast. Median follow-up time was 12.3 years. Results There were 99 IBEs, of which 51 (52%) were invasive. The IBE and invasive IBE rates increased over time in both cohorts. The 12-year rates of developing an IBE were 14.4% for cohort 1 and 24.6% for cohort 2 (P = .003). The 12-year rates of developing an invasive IBE were 7.5% and 13.4%, respectively (P = .08). On multivariable analysis, study cohort and tumor size were both significantly associated with developing an IBE (P = .009 and P = .03, respectively). Conclusion For patients with DCIS selected for favorable clinical and pathologic characteristics and treated with excision without radiation, the risks of developing an IBE and an invasive IBE increased through 12 years of follow-up, without plateau. These data help inform the treatment decision-making process for patients and their physicians.

scholarly journals Malignant Phyllodes Tumour with Liposarcomatous Differentiation, Invasive Tubular Carcinoma, and Ductal and Lobular Carcinoma In Situ: Case Report and Review of the Literature

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Mardiana Abdul Aziz ◽  
Frank Sullivan ◽  
Michael J. Kerin ◽  
Grace Callagy
Keyword(s):  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Lobular Carcinoma In Situ ◽  
Tubular Carcinoma ◽  
In Situ Carcinoma ◽  
Phyllodes Tumour ◽  
Radiotherapy Treatment ◽  
Malignant Phyllodes Tumour

A 43-year-old woman presented with a right breast lump that had enlarged over 5 months. She had chemoradiotherapy for non-Hodgkin’s lymphoma in 1989. Histology revealed a malignant phyllodes tumour (PT) with liposarcomatous differentiation and ductal carcinoma in situ (DCIS) within the tumour with invasive tubular carcinoma, DCIS, and lobular carcinoma in situ in the surrounding breast. She had surgery and adjuvant radiotherapy. One year follow-up showed no recurrence or metastatic disease. Liposarcomatous differentiation is uncommon in PTs, and coexisting carcinoma is rare with 38 cases in 31 reports in the literature. Carcinoma is reported in malignant (), benign () and in borderline PTs () with invasive carcinoma () and pure in situ carcinoma () recorded in equal frequency. Carcinoma is more commonly found within the confines of benign PTs; whereas it is more often found surrounding the PT or in the contralateral breast in malignant PTs. Previous radiotherapy treatment is reported in only two cases. The aetiology of co-existing carcinoma is unclear but the rarity of previous radiotherapy treatment suggests that it is incidental. This case highlights the diverse pathology that can occur with PTs, which should be considered when evaluating pathology specimens as they may impact on patient management.

scholarly journals B3 Lesions at Vacuum-Assisted Breast Biopsy under Ultrasound or Mammography Guidance: A Single-Center Experience on 3634 Consecutive Biopsies

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5443
Author(s):  
Veronica Girardi ◽  
Monica Guaragni ◽  
Nella Ruzzenenti ◽  
Fabrizio Palmieri ◽  
Gianluca Fogazzi ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Tumor Board ◽  
Consecutive Series ◽  
Single Center Experience ◽  
Significant Difference ◽  
B3 Lesions

The rate of upgrade to cancer for breast lesions with uncertain malignant potential (B3 lesions) diagnosed at needle biopsy is highly influenced by several factors, but large series are seldom available. We retrospectively assessed the upgrade rates of a consecutive series of B3 lesions diagnosed at ultrasound- or mammography-guided vacuum-assisted biopsy (VAB) at an EUSOMA-certified Breast Unit over a 7-year timeframe. The upgrade rate was defined as the number of ductal carcinoma in situ (DCIS) or invasive cancer at pathology after excision or during follow-up divided by the total number of B3 lesions. All lesions were reviewed by one of four pathologists with a second opinion for discordant assessments of borderline cases. Excision or surveillance were defined by the multidisciplinary tumor board, with 6- and 12-month follow-up. Out of 3634 VABs (63% ultrasound-guided), 604 (17%) yielded a B3 lesion. After excision, 17/604 B3 lesions were finally upgraded to malignancy (2.8%, 95% confidence interval [CI] 1.8–4.5%), 10/17 (59%) being upgraded to DCIS and 7/17 (41%) to invasive carcinoma. No cases were upgraded during follow-up. B3a lesions showed a significantly lower upgrade rate (0.4%, 95% CI 0.1–2.1%) than B3b lesions (4.7%, 95% CI 2.9–7.5%, p = 0.001), that had a 22.0 adjusted odds ratio for upgrade (95% CI 2.1–232.3). No significant difference was found in upgrade rates according to imaging guidance or needle caliper. Surveillance-oriented management can be considered for B3a lesions, while surgical excision should be pursued for B3b lesions.

scholarly journals Managing Recurrent Orbital Lymphangioma in a Pubertal Female with Negative Pressure Aspiration and Intralesional Bleomycin Injection: A Case Report

2021 ◽  
Vol 13 (1) ◽  
pp. 157-161
Author(s):  
Santosh Chaudhary ◽  
Aashish Raj Pant ◽  
Badri Prasad Badhu
Keyword(s):  
Case Report ◽  
Negative Pressure ◽  
Surgical Excision ◽  
Successful Management ◽  
Minimal Intervention ◽  
Sclerosing Agents ◽  
Complete Surgical Excision ◽  
The Right

Introduction: Management of orbital lymphangioma is challenging. Complete surgical excision is often impossible due to its infiltrative nature. Sclerosing agents have been used in its management with variable outcomes. We report a case of recurrent orbital lymphangioma managed with intralesional bleomycin.  Case: A 14-year-old female presented with proptosis of the right eye for two weeks. She had a similar history at five years of age for which she underwent surgical excision. We performed negative pressure aspiration using a 20-gauge angiocatheter, injected bleomycin, and left the cannula in situ for repeat aspiration to maintain cyst collapse.  Observation: The lymphangioma regressed, and there was no recurrence at six months of follow-up.  Conclusion: This report highlights the use of negative pressure aspiration and intralesional bleomycin injection by minimal intervention using angiocatheter in the successful management of orbital lymphangioma.

Low diffusion level within a fibroadenoma as the sole sign of ductal carcinoma in situ: A case report

2021 ◽  
pp. 1-4
Author(s):  
Corrado Tagliati ◽  
Giuseppe Lanni ◽  
Federico Cerimele ◽  
Antonietta Di Martino ◽  
Valentina Calamita ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Surgical Excision ◽  
Small Region ◽  
Apparent Diffusion Coefficient Value ◽  
Apparent Diffusion

We present a case of ductal carcinoma in situ within a fibroadenoma. Breast cancer arising within fibroadenoma incidence ranges from 0.125% to 0.02%, and ductal carcinoma in situ is not the most frequent malignancy that can be found within a fibroadenoma. Dynamic contrast-enhanced magnetic resonance imaging showed an oval mass with circumscribed margins and dark internal septations, suspicious for fibroadenoma. According to European Society of Breast Radiology diffusion-weighted imaging consensus, mean apparent diffusion coefficient value obtained by drawing a small region of interest on the lesion apparent diffusion coefficient map showed a low diffusion level. Therefore, ductal carcinoma in situ within a fibroadenoma was diagnosed at final pathology after surgical excision.

Breast-Conserving Treatment With or Without Radiotherapy in Ductal Carcinoma-In-Situ: Ten-Year Results of European Organisation for Research and Treatment of Cancer Randomized Phase III Trial 10853—A Study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group

2006 ◽  
Vol 24 (21) ◽  
pp. 3381-3387 ◽  
Author(s):  
Nina Bijker ◽  
Philip Meijnen ◽  
Johannes L. Peterse ◽  
Jan Bogaerts ◽  
Irène Van Hoorebeeck ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Phase Iii ◽  
Breast Conserving Treatment ◽  
European Organisation ◽  
Radiotherapy Group ◽  
Long Term Follow Up

Purpose The European Organisation for Research and Treatment of Cancer conducted a randomized trial investigating the role of radiotherapy (RT) after local excision (LE) of ductal carcinoma-in-situ (DCIS) of the breast. We analyzed the efficacy of RT with 10 years follow-up on both the overall risk of local recurrence (LR) and related to clinical, histologic, and treatment factors. Patients and Methods After complete LE, women with DCIS were randomly assigned to no further treatment or RT (50 Gy). One thousand ten women with mostly (71%) mammographically detected DCIS were included. The median follow-up was 10.5 years. Results The 10-year LR-free rate was 74% in the group treated with LE alone compared with 85% in the women treated by LE plus RT (log-rank P < .0001; hazard ratio [HR] = 0.53). The risk of DCIS and invasive LR was reduced by 48% (P = .0011) and 42% (P = .0065) respectively. Both groups had similar low risks of metastases and death. At multivariate analysis, factors significantly associated with an increased LR risk were young age (≤ 40 years; HR = 1.89), symptomatic detection (HR = 1.55), intermediately or poorly differentiated DCIS (as opposed to well-differentiated DCIS; HR = 1.85 and HR = 1.61 respectively), cribriform or solid growth pattern (as opposed to clinging/micropapillary subtypes; HR = 2.39 and HR = 2.25 respectively), doubtful margins (HR = 1.84), and treatment by LE alone (HR = 1.82). The effect of RT was homogeneous across all assessed risk factors. Conclusion With long-term follow-up, RT after LE for DCIS continued to reduce the risk of LR, with a 47% reduction at 10 years. All patient subgroups benefited from RT.

scholarly journals Ductal carcinoma in situ presenting as a cystic retroareolar lesion in an African American man

2021 ◽  
Author(s):  
Amara Ndumele ◽  
Amy Kerger ◽  
Gary Tozbikian ◽  
Samilia Obeng-Gyasi ◽  
Bridget Oppong
Keyword(s):  
African American ◽  
Health Outcomes ◽  
Chest Wall ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Cystic Lesion ◽  
Ductal Carcinoma ◽  
Unusual Finding

We report an unusual finding of DCIS within a cystic lesion in a black man highlighting the need for adequate workup, and timely follow-up for men with breast/chest wall masses given the lack of screening in this population. Furthermore, we will explore how race contributes to prognosis and health outcomes.

scholarly journals Complex fibroadenoma with focal ossification- an enigmatic finding in a less common tumor

2021 ◽  
Vol 8 (5) ◽  
pp. 1650
Author(s):  
Subhransu Kumar Hota ◽  
Ranjana Giri ◽  
Hardik Kabra ◽  
Devika Chauhan ◽  
Prita Pradhan ◽  
...  
Keyword(s):  
Excision Biopsy ◽  
Radiological Findings ◽  
Breast Lump ◽  
In Situ Carcinoma ◽  
Unusual Occurrence ◽  
Malignant Lesions ◽  
Breast Lumps ◽  
Sclerosing Adenosis

Breast lumps have diverse causes including benign as well as malignant lesions. Fibroadenoma (FA) is a common cause of breast lump. Complex fibroadenomas, a particular subtype, pose diagnostic dilemmas due to confusing the radiological findings and hold higher incidence of transformation to malignancy. A 49 year old female presented with a painless lump in right breast for 2 years which appeared calcified on radiology. Excision biopsy was performed which grossly revealed an encapsulated grey-white firm to hard with cystic areas. Microscopically the sections showed a well encapsulated fibroepithelial tumor showing areas of sclerosing adenosis, hyalinization, cysts lined by cuboidal cells with eosinophilic secretions, areas of calcification and ossification. No evidence of lobular hyperplasia or in-situ carcinoma was seen. Patient was advised follow up. This case represents the unusual occurrence of complex fibroadenoma in a middle-aged female showing with ossification.

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