Apocrine Breast Carcinoma - Pathohistological And Immunohistochemical Analysis, Prognosis and Complex Treatment

Apocrine breast cancer (ABC) is a rarely diagnosed pathomorphological subtype of invasive ductal carcinoma of the breast. We present a clinical case of apocrine breast cancer in a 36-year-old woman. A left-sided breast-preserving surgery (quadrantectomy am blok with underlying muscle fascia) and axillary lymph dissection at all three levels were performed. The complex treatment is continued with adjuvant chemotherapy, followed by radiotherapy of the left mammary gland. The pathomorphological and immunohistochemical characteristics of apocrine breast cancer, the prognosis and the necessary complex treatment are discussed. Immunohistochemical (IHC) analysis of apocrine carcinoma cells reported a characteristic steroid receptor profile with negative IHC expression for estrogen and progesterone receptors and positive for androgen receptors. ABC is prognostically similar to invasive ductal carcinoma / NOS. Apocrine breast cancer needs to be classified as a separate nosological unit, due to growing evidence of a different hormonal profile with different clinical behavior following androgen deprivation therapy.

Krūtį tausojančios operacijos ir kombinuotojo gydymo rezultatai

Valerijus Ostapenko1, Saulius Bružas1, Algimantas Mudėnas1, Jonas Sabonis1, Algirdas Jackevičius1, Juozas Kurtinaitis1, Anatolijus Ostapenko2, Narimantas Evaldas Samalavičius1, Laima Bloznelytė-Plėšnienė1 1 Vilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08661 Vilnius2 Vilniaus universiteto Medicinos fakultetas, Čiurlionio g. 21, LT-03101 VilniusEl. paštas: [email protected] TikslasKrūtį tausojančios operacijos (KTO) pastaruoju metu yra pripažintas krūties vėžio gydymas, kuriam chirurgija teikia pirmumą. Krūtį tausojančių operacijų skaičius didėja industrinėse pasaulio šalyse, taip pat ir Lietuvoje. Šio darbo tikslas – įvertinti Vilniaus universiteto Onkologijos instituto (VUOI) KTO kombinuotojo gydymo rezultatus. Ligoniai ir metodaiDarbe atliekama retrospektyvi 349 pacienčių, sergančių I, II, III stadijos krūties vėžiu ir gydytų KTO, analizė. Visoms pacientėms buvo taikytas kombinuotasis gydymas. Ligonių amžius mediana buvo 51 metai, stebėjimo mediana – 9,4 metų. RezultataiBendras ligonių, sergančių I stadijos krūties vėžiu, penkerių išgyvenimas 93,6 % (88,3–96,5), II stadijos – 76,4 % (69,5–81,9), o III – 64,0 % (42,2–79,4). Pasitaikė 22 lokalūs recidyvai. Atkryčio išsivystymo tikimybė siekė 8,0 % (5,2 %–12,3 %). IšvadaDarbo rezultatai leidžia teigti, kad KTO įdiegus VUOI, atkryčių nepadaugėjo, o bendrieji išgyvenimo rezultatai buvo panašūs į tarptautinių randomizuotų klinikinių studijų rezultatus. Reikšminiai žodžiai: krūties vėžys, krūtį tausojančios operacijos, gydymo rezultatai. Breast preserving surgery and results of combined treatment Valerijus Ostapenko1, Saulius Bružas1, Algimantas Mudėnas1, Jonas Sabonis1, Algirdas Jackevičius1, Juozas Kurtinaitis1, Anatolijus Ostapenko2, Narimantas Evaldas Samalavičius1, Laima Bloznelytė-Plėšnienė1 1 Institute of Oncology,Vilnius University, Santariškių Str. 1, LT-08661 Vilnius, Lithuania2 Medical Faculty Vilnaus University, Čiurlionio Str. 21, LT-03101 Vilnius, LithuaniaE-mail: [email protected] BackgroundBreast conservation therapy (BCT) is now well established as an oncologically safe treatment for primary breast cancer. BCT rates are growing in industrial countries, also in Lithuania. The aim of the study was to analyze the results of combined treatment of breast conservation therapy at the Oncology Institute of Vilnius University. Patients and methodsA retrospective analysis of 376 patients with stages I, II, III breast cancer, who underwent BCT treatment at the Oncology Institute of Vilnius University in 1999–2000, was performed. The patients’ age median was 51 years and the follow-up median 9.4 years. ResultsThe overall 5-year survival in stage I was 93.6% (88.3–96.5), stage II – 76.4% (69.5–81.9), stage III – 64.0% (42.2–79.4); 22 local recurrences were observed. The cumulative probability of local recurrence was estimated to be 8.0% (5.2–12.3%). ConclusionsThe implementation of BCT at the Oncology Institute of Vilnius University did not peaked the recurrence rates, and patients’ survival was found to be comparable to the findings of randomized clinical studies. Keywords: breast cancer, breast-preserving surgery, results of combined treatment.

Tamoxifen Versus Control After Adjuvant, Risk-Adapted Chemotherapy in Postmenopausal, Receptor-Negative Patients With Breast Cancer: A Randomized Trial (GABG-IV D-93)—The German Adjuvant Breast Cancer Group

Purpose To investigate the effect of adjuvant sequential tamoxifen after chemotherapy in postmenopausal patients with hormone receptor–negative breast cancer. Methods Patients were randomly assigned to oral tamoxifen (30 mg daily for 5 years; n = 421) or no additional treatment (n = 408) after risk-adapted polychemotherapy consisting of three 28-day cycles of CMF (cyclophosphamide, 500 mg/m2, methotrexate, 40 mg/m2, and fluorouracil, 600 mg/m2) in patients with negative or one to three positive lymph nodes and four 21-day cycles of epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2 followed by three cycles of CMF in patients with four to nine positive lymph nodes. Results Thirty-six percent of the patients included were older than 60 years, 63% were node negative, 13% had four to nine positive nodes, 55% had tumor grade 3, and 41% received breast-preserving surgery. At 5.3 years’ median follow-up, the first event of failure (recurrence, secondary tumor, or death) had occurred in 123 patients in the tamoxifen group and 107 patients of the control group. Event-free survival rates after 5 years were 70.3% (95% CI, 65.5% to 75.0%) and 72.8% (95% CI, 68.2% to 77.5%) for the tamoxifen and control groups, respectively. The estimated hazard ratio of tamoxifen versus control was 1.13 (95% CI, 0.87 to 1.48; P = .34), which gives no indication of an additional benefit of tamoxifen in these patients. Conclusion This study contributes substantially to finalization of the presently emerging evidence that tamoxifen does not benefit women with receptor-negative breast cancer after chemotherapy.