Breast Cancer: A Revolutionary Concept

Male breast: An unusual case of metastasis of squamous cell carcinoma of the skin

Breast metastasis from extra-mammary neoplasm is a rare condition, accounting for approximately 1.2%-2% of all breast malignancies. Melanoma, lung cancer, gynecological, and hematological cancers can metastasis to the breast. Male breast metastasis is extremely rare and, no evidence of metastasis from cutaneous squamous cell carcinoma in a male breast have been reported to our knowledge. We describe a case of an 81-year-old man who came to our attention for a palpable solid mass in the upper-outer aspect of the left breast with the final histological diagnosis of breast metastasis from non-keratoblastic cutaneous squamous cell carcinoma.

Breast metastasis of signet ring cell carcinoma from the colon: a case report

BACKGROUND

Colon cancer is one of the most common diagnosed malignancies. Despite the use of surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, and other comprehensive treatments, distant metastasis is still one of the main causes for dying of colon cancer. The common metastatic site of colon cancer is the liver, lung, and bone. In this article, we report a rare case of breast metastasis of signet ring cell carcinoma from the colon.

CASE PRESENTATION

A 44-year-old woman was diagnosed with colon cancer and received a radical surgery of colon cancer in 2019. Combined with postoperative pathological and computed tomography (CT) images, a diagnosis of cT3N2M0 mucinous adenocarcinoma of colon (according to AJCC cancer staging manual, Version 8) was established. Adjuvant chemotherapy (XELOX: oxaliplatin 130 mg/m² on day 1 plus capecitabine 1000 mg/m² twice daily on days 1 to 14 every 3 weeks for 18 weeks) was performed followed by surgical resection. Fourteen months later, the patient underwent mastectomy for breast mass, which was diagnosed pathologically as metastasis of signet ring cell carcinoma from the colon. XELOX chemotherapy regimen (oxaliplatin 130 mg/m² on day 1 plus capecitabine 1000 mg/m² twice daily on days 1 to 14 every 3 weeks for 24 weeks) combined with bevacizumab (7.5 mg/kg on day 1) was used after the mastectomy. The patient had stable disease according to her last examination (RECIST criteria).

CONCLUSION

It is rare to find a report of a patient of colon cancer that metastasizes to breast. We hope to increase treatment experience for patients with this rare metastasis.

Characteristics of metastasis in the breast from extramammary malignancies

BACKGROUND AND OBJECTIVE

Breast metastasis from extramammary neoplasm is rare. We present the cases of metastasis to the breast after review of results in one institute and we want to show the difference of previous report.

METHODS

The surgical and pathology databases of Samsung Medical Center from November 1994 to March 2009 were investigated to identify all patients with a diagnosis of metastasis to the breast.

RESULTS

Thirty-three patients with breast metastases from extramammary neoplasm were studied. Gastric carcinoma was most common metastatic origin in this study. There were four cases with microcalcifications in their metastatic lesions. This is the first report of microcalcification of metastatic lesions to the breast from hepatocellular carcinoma and gastric cancer.

CONCLUSIONS

Pathologic examination and considering known clinical history may be helpful to differentiate the primary breast cancer and metastatic cancer. Metastasis to the breast from an extramammary neoplasm usually indicates disseminated metastatic disease and a poor prognosis. An accurate diagnosis of breast metastases, differentiating primary from metastatic breast carcinoma, is important for proper management.

Breast metastases from colorectal carcinoma

A case history is presented of a 53-year-old woman with an incidental finding of a breast lump, identified after having had chemotherapy for lung metastases from a rectal carcinoma. Clinical examination, ultrasound, mammography, fine needle aspiration and core biopsies could not prove definitively whether the breast lump represented a metastasis from colorectal carcinoma. Following local excision, the final diagnosis of metastatic colorectal carcinoma to the breast was based on the absence of any site of origin within the breast (i.e. no surrounding DCIS) and on the expression of cytokeratin CK7 and CK20 on immunohistochemistry. Postoperative chemotherapy was initiated. Four months later, although without local recurrence in the breast, the patient developed cutaneous metastatic deposits and active treatment was stopped. A review of other cases of breast metastases from extramammary sources is presented. Possible mechanisms for this rare and unusual phenomenon are discussed.

Neoadjuvant antiangiogenic therapy with tamoxifen does not impair gastrointestinal anastomotic repair in the rat

INTRODUCTION

Antiangiogenic therapy has the potential to moderate tumour and micrometastatic growth. Its use in the perioperative period is attractive but its potential to compromise wound and anastomotic healing is a cause for concern. Tamoxifen is antiangiogenic but also favourably modifies some aspects of wound healing. We hypothesised that tamoxifen would not adversely affect skin wound and gut anastomotic healing.

METHODS

A previously established model of tamoxifen, administered orally at antiangiogenic doses (20 mg/ml arachais oil/day), was used. Animals received two days pretreatment prior to laparotomy and small bowel anastomosis. Treatment was continued until completion of the study. The principal outcome measures are survival, macroscopic wound and anastomotic healing, anastomotic bursting pressure and PVA sponge granuloma hydroxyproline (OHP) content.

RESULTS

Tamoxifen treated animals had fewer complications of skin wound healing than controls (4.5% vs. 19.5%; chi(2) 4.65, 1 d.f., P < 0.05). There was no significant difference in adhesion formation or macroscopic complications of anastomotic healing. Anastomotic bursting pressure was greater in tamoxifen treated animals at postoperative day 3 (39 +/- 4.4 vs. 22.5 +/- 3.5 mmHg; P < 0.01) and equal to that of controls on postoperative day 5 (144.4 +/- 9.4 vs. 127.3 +/- 10.9 mmHg; P = ns). Tamoxifen treated animals weighed significantly less than placebo controls from postoperative day 3 with no difference in mortality between groups (chi(2) = 0.06, 1 d.f., P = ns). PVA sponge granuloma OHP content on day 7 was higher in tamoxifen-treated animals (2.93 +/- 0.4 vs. 1.4 +/- 0.4 mg OHP/mg dry sponge weight; P = 0.03).

CONCLUSION

Antiangiogenic therapy with tamoxifen has no demonstrable adverse effects on wound or anastomotic repair and its perioperative use is compatible with successful early surgical outcomes.

Evolution of Hodgkin's disease

Hodgkin's disease is an oncogenic core disorder characterized by both mitotic and amitotic neoplastic multiplication, and is associated with collateral disorders such as lacunar formation and leukocytic infiltration. Research has demonstrated that Hodgkin's disease progresses stepwise, beginning with a reversible, biological stage during which Hodgkin and Reed-Sternberg cells are formed, followed by constitutive, but reversible Hodgkinogenic medical stage that leads to an irreversible, systemic and fatal proto-oncogenic stage. This disease results from collateral activation of cytokine and archaic oncogenes, suppression of DNA repair genes in multiple chromosomes. The variability of Hodgkin's disease manifestations has required antisynthetic (antimetabolites, radiotherapy), anti-viral (acyclovir) and anti-mitotic (vincristine, vinblastine) for different loci minores of treatment. Continued molecular biological research of the ancestral and prokaryotic oncogenes is recommended.

Breast cancer--a challenge to the contemporary paradigm

There is much triumphalism about the apparent progress in the diagnosis and management of breast cancer and yet the impact on mortality from this disease in both the United States of America and Europe has been quite trivial. The early results of adjuvant systemic therapy have been sustained out of 15 to 20 years, which presumably accounts for the majority of the mortality reductions we are seeing, yet it is my impression that progress has slowed down, if not plateaued. For that reason it is time to reconsider our prejudices and recognize that we will need another conceptual revolution before there is the next important incremental step forward. It is here proposed that the current concepts on the initiation and progress of micrometastases are wrong and that we need to develop a new paradigm based on our current knowledge of cell and molecular biology which recognizes that occult metastases that ultimately are the cause of breast cancer mortality are complex organisms, maintained in the state of dynamic equilibrium. This equilibrium can be perturbed by 'premature' surgery, so that the whole concept of 'early diagnosis' and prompt treatment might be fundamentally flawed. Therapeutic interventions that may control rather than 'cure' breast cancer using biological specific modalities rather than non-specific cytotoxic drugs could provide some of the answers. An even more radical challenge to the contemporary paradigm is suggested. Perhaps not all metastases are cellular phenomena, maybe in vivo transfection by endogenous retroviral-like particles allows breast cancer to escape destruction by chemotherapy?