1
|
Esperança-Martins M, Melo-Alvim C, Dâmaso S, Lopes-Brás R, Peniche T, Nogueira-Costa G, Abreu C, Luna Pais H, de Sousa RT, Torres S, Gallego-Paez LM, Martins M, Ribeiro L, Costa L. Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Turning the Magnifying Glass on Rare and Aggressive Entities. Cancers (Basel) 2023; 15:3933. [PMID: 37568749 PMCID: PMC10416994 DOI: 10.3390/cancers15153933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Breast sarcomas (BSs), phyllodes tumors (PTs), and desmoid tumors (DTs) are rare entities that arise from connective tissue. BSs can be classified as either primary or secondary, whether they develop de novo or after radiation exposure or lymphedema. PIK3CA seems to play an important common role in different BS. Malignant PTs show similar behavior to BSs, while DTs are locally aggressive but rarely metastasize. BSs usually present as unilateral, painless, rapidly growing masses with rare nodal involvement. The diagnosis should be based on magnetic resonance imaging and a core needle biopsy. Staging should comprise a chest computed tomography (CT) scan (except for benign PT and DT), while abdominal and pelvic CT scans and bone scans should be added in certain subtypes. The mainstay of treatment for localized BS is surgery, with margin goals that vary according to subtype. Radiotherapy and chemotherapy can be used as neoadjuvant or adjuvant approaches, but their use in these settings is not standard. Advanced BS should be treated with systemic therapy, consistent with recommendations for advanced soft tissue sarcomas of other topographies. Given the rarity and heterogeneity of these entities, multidisciplinary and multi-institutional collaboration and treatment at reference centers are critical.
Collapse
Affiliation(s)
- Miguel Esperança-Martins
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Cecília Melo-Alvim
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sara Dâmaso
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Raquel Lopes-Brás
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Tânia Peniche
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Gonçalo Nogueira-Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Catarina Abreu
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Helena Luna Pais
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Rita Teixeira de Sousa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Sofia Torres
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
| | - Lina Marcela Gallego-Paez
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Marta Martins
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
| | - Leonor Ribeiro
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Luís Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.M.-A.); (S.D.); (R.L.-B.); (G.N.-C.); (C.A.); (H.L.P.); (R.T.d.S.); (S.T.); (L.R.)
- Luis Costa Lab, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal; (T.P.); (L.M.G.-P.); (M.M.)
- Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
| |
Collapse
|
2
|
Kokkali S, Moreno JD, Klijanienko J, Theocharis S. Clinical and Molecular Insights of Radiation-Induced Breast Sarcomas: Is There Hope on the Horizon for Effective Treatment of This Aggressive Disease? Int J Mol Sci 2022; 23:ijms23084125. [PMID: 35456944 PMCID: PMC9029574 DOI: 10.3390/ijms23084125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Radiation-induced breast sarcomas (RIBS) are rare entities representing <1% of all primary breast malignancies, limiting most reports to small retrospective case series. They constitute a heterogeneous group of neoplasms, with high-grade angiosarcoma being the most common subtype. Other sarcoma histotypes, such as undifferentiated pleomorphic sarcoma and leiomyosarcoma, can also be identified. Radiation-induced breast angiosarcoma (RIBA) has an incidence of approximately 0.1% after breast-conserving therapy and arises mainly from the dermis of the irradiated breast. MYC gene amplification is highly indicative of secondary breast angiosarcomas. Their clinical presentation often mimics benign port-radiation lesions, leading to a delay in diagnosis and a lost window of opportunity for cure. Surgery with negative margins is the mainstay of treatment of localized RIBS. In the case of angiosarcoma, technical difficulties, including multifocality, infiltrative margins, and difficulty in assessing tumor margins, render surgical treatment quite challenging. A limited number of studies showed that adjuvant radiation therapy reduces local recurrences; therefore, it is proposed by many groups for large, high-grade tumors. Chemotherapy has been evaluated retrospectively in a small subset of patients, with some evidence supporting its use in angiosarcoma patients. Approximately half of patients with RIBA will show local recurrence. In the advanced setting, different therapeutic options are discussed in the review, including chemotherapy, antiangiogenic therapy, and immunotherapy, whereas the need for further research on molecular therapeutic targets is pointed out.
Collapse
Affiliation(s)
- Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
- Oncology Unit, 2nd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippocratio General Hospital of Athens, V. Sofias 114, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6932326547
| | - Jose Duran Moreno
- Hellenic Group of Sarcoma and Rare Cancers, G. Theologou 5, 11471 Athens, Greece;
| | - Jerzy Klijanienko
- Department of Pathology, Institut Curie, 26 Rue d’Ulm, CEDEX 05, 75248 Paris, France;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| |
Collapse
|
3
|
Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
Collapse
Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
| | | |
Collapse
|
4
|
Male Breast Cancer in Togo: Imaging and Clinicopathological Findings. Int J Breast Cancer 2020; 2020:3056067. [PMID: 32934847 PMCID: PMC7479472 DOI: 10.1155/2020/3056067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Breast cancer in men is a rare condition, often diagnosed late. The purpose of this study was to describe its epidemiological, histopathological, and radiographic aspects in Togo. Materials and Methods This was a descriptive retrospective study on cases of breast cancer in humans diagnosed histologically at the Laboratory of Anatomy Pathological and Imagery of the University Hospital in Lomé, over a period of 25 years (1995 to 2019). The parameters studied were epidemiological, anatomopathological, and imaging. Results Eighty-two (82) cases were diagnosed, an annual frequency of 3.28 cases. The mean age was 45 ± 2.5 years; the range was 27-63 years. The family history of 47 patients (57.32%) was known. Carcinomas represented the predominant histological group with predominantly nonspecific invasive carcinoma (87.5%). These cancers were diagnosed at late stages (75.71% grade II). They were mainly of luminal B profile (38.75%) and associated with mutations of the BRCA2 and BRCA1 genes in 14.63% of the cases. The lesions were classified ACR 5 in 61.5% (11/18). Two cases of breast angiosarcoma were diagnosed by the identification of CD31 markers and factor VIII in immunohistochemistry. Hormone therapy such as tamoxifen was prescribed in all luminal patients (43 patients). Radiotherapy was administered to 15 patients (18.3%), with acute toxicity in 20% of the cases. After a median follow-up of 36 months, the evolution was complete remission in 27 patients (32.93%). Conclusion Breast cancer in men is rare, often diagnosed late with a poor prognosis.
Collapse
|
5
|
Darré T, Brun LVC, Seidou F, Djiwa T, Ballé MC, Napo-Koura G. Giant primary angiosarcoma of an adolescent girl's breast diagnosed postmortem: a case report. J Med Case Rep 2020; 14:80. [PMID: 32591009 PMCID: PMC7320594 DOI: 10.1186/s13256-020-02403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Angiosarcoma is an endothelial malignant tumor; angiosarcoma located in the breast is extremely rare, less than 0.01%. We report a case of a giant angiosarcoma diagnosed postmortem in a 16-year-old girl in a resource-constrained country. Case presentation A 16-year-old black African girl was admitted for altered consciousness and a left breast tumor. She was admitted in a state of apparent death. Her death was confirmed on clinical examination. A postmortem biopsy of the mammary tumor showed standard histology of a proliferation of fusiform or rounded tumor cells in places, which were not very cohesive with marked anisokaryosis and numerous foci of tumor necrosis. Immunohistochemistry showed a positivity of CD31 and factor VIII markers with a proliferation index (Ki-67) estimated at 30%. Conclusion Primary angiosarcoma of the breast is exceptional in adolescents and has a poor prognosis, especially in countries with limited resources.
Collapse
Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, BP 1515, Togo.
| | | | - Falilath Seidou
- Department of Pathology, University Teaching Hospital of Parakou, Cotonou, Bénin
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, BP 1515, Togo
| | - Marie Claire Ballé
- Department of Pathology, University Teaching Hospital of Parakou, Cotonou, Bénin
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, BP 1515, Togo
| |
Collapse
|
6
|
Terenzi V, Cassoni A, Della Monaca M, Di Benedetto G, Priore P, Battisti A, Valentini V. The difficult management of radio-incuced head and neck sarcomas. Oral Oncol 2017; 73:173-174. [PMID: 28789828 DOI: 10.1016/j.oraloncology.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Valentina Terenzi
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy.
| | - Andrea Cassoni
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy
| | - Marco Della Monaca
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy
| | - Giulia Di Benedetto
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy
| | - Paolo Priore
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy
| | - Andrea Battisti
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy
| | - Valentino Valentini
- Odontostomatological Science and Maxillofacial Surgery Department, "Sapienza" University or Rome, Viale del Policlinico, 155, Italy
| |
Collapse
|
7
|
Huntington JT, Jones C, Liebner DA, Chen JL, Pollock RE. Angiosarcoma: A rare malignancy with protean clinical presentations. J Surg Oncol 2015; 111:941-50. [PMID: 26031299 DOI: 10.1002/jso.23918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
Abstract
Angiosarcoma is a rare form of soft tissue sarcoma. Primary small intestinal angiosarcomas are especially uncommon. The clinical presentations of small intestinal angiosarcomas vary but gastrointestinal (GI) bleeding is a frequent finding. We present a case of persistent GI bleeding of unknown etiology culminating in operative exploration demonstrating a primary small intestinal angiosarcoma. A discussion of the diagnosis, pathology, and management of angiosarcoma with a review of the current literature is provided including molecular genetics, difficult cases, and current treatment options.
Collapse
Affiliation(s)
- Justin T Huntington
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christian Jones
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David A Liebner
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - James L Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Raphael E Pollock
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center - James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| |
Collapse
|
8
|
Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver - the use of imaging biomarkers as predictors of patient survival. Eur J Radiol 2014; 84:424-430. [PMID: 25542065 DOI: 10.1016/j.ejrad.2014.11.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/14/2014] [Accepted: 11/28/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE). MATERIALS/METHODS This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. The safety profile, overall survival (OS) and progression-free survival (PFS) after the procedure were evaluated. Tumor response in each patient was assessed using RECIST, modified (m) RECIST and EASL guidelines. In addition, a 3D quantification of the enhancing tumor volume (quantitative [q] EASL) was performed. For each method, patients were classified as responders (R) and non-responders (NR), and evaluated using Kaplan-Meier and multivariate Cox proportional hazard ratio (HR) analysis. RESULTS No Grade III or IV toxicities were reported in a total of 77 procedures (mean, 2.6/patient). Median OS was 21.2 months (95% CI, 13.4-28.9) and PFS was 6.3 months (95% CI, 4.4-8.2). The enhancement-based techniques identified 11 (44%), 12 (48%) and 12 (48%) patients as R according to EASL, mRECIST and qEASL, respectively. No stratification was achieved with RECIST. Multivariate analysis identified tumor response according to mRECIST and qEASL as reliable predictors of improved patient survival (P=0.019; HR 0.3 [0.1-0.8] and P=0.006; HR 0.2 [0.1-0.6], respectively). CONCLUSION This study confirmed the role of cTACE as a safe salvage therapy option in patients with mSTS of the liver. The demonstrated advantages of enhancement-based tumor response assessment techniques over size-based criteria validate mRECIST and qEASL as preferable methods after intraarterial therapy.
Collapse
|