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Aghajanzadeh M, Torabi H, Najafi B, Talebi P, Shirini K. Intermammary breast cancer: A rare case of cancer with origin of breast cells in an unusual location. SAGE Open Med Case Rep 2023; 11:2050313X231154996. [PMID: 36798680 PMCID: PMC9926372 DOI: 10.1177/2050313x231154996] [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: 10/17/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
The most common type of cancer among the female population is breast cancer. The most common site for the occurrence of breast cancer is the upper outer quadrant; the upper inner quadrant is the second site, and both the lower outer and the lower inner quadrants are in the third place. This problem is rarely seen in the central portion. Intermammary metastasis due to breast cancer is an infrequent finding. This article presents a 62-year-old lady who presented to the surgical ward with intermammary swelling that appeared suddenly 3 months ago. Ultrasound examination showed a hypoechoic micro-lobulated mass with internal vascularity on the chest wall. Although core needle biopsy suspected invasive ductal carcinoma, both right and left axillary lymph nodes were normal and free. The patient was consulted by an oncologist who recommended radiotherapy before surgery and chemotherapy before and after surgery. This study aims to report and discuss a rare case of intermammary cancer with the origin of breast cells without breast and axillary lymph node involvement. Although the intermammary region is an extremely rare location where breast cancer could occur, its management strategy is the same as other breast cancers.
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Affiliation(s)
| | - Hossein Torabi
- Department of General Surgery, Poursina Medical and Educational Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Behrouz Najafi
- Department of Oncology, Guilan University of Medical Sciences, Rasht, Iran
| | - Pedram Talebi
- Department of Pathology, Guilan University of Medical Sciences, Rasht, Iran
| | - Kasra Shirini
- Department of General Surgery, Iran University of Medical Science, Tehran, Iran,Kasra Shirini, Department of General Surgery, Iran University of Medical Science, Tehran 1449614535, Iran.
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Lin H, Lin J, Wu Y, Liang G, Sun J, Chen L. Exploring the Prognosis of Breast Cancer with Synchronous Distant Nonregional Lymph Node Metastasis and Establishing a Predictive Model: A Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5027457. [PMID: 35071594 PMCID: PMC8769852 DOI: 10.1155/2022/5027457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We aimed to explore the prognosis of breast cancer patients with synchronous isolated distant-lymph node metastasis (SDLNM). METHODS We extracted information from the Surveillance, Epidemiology, and End Results Program. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS). Fine-Gray test was utilized to compare breast cancer-specific survival (BCSS). We applied propensity score matching (PSM) to balance confounders. In total, 692 SDLNM patients were allocated into training and validation cohorts. Univariate and multivariate analyses were implemented to determine independent prognostic variables. A nomogram predicting OS of SDLNM patients was constructed. Calibration curves and receiver operating characteristic curves were utilized to access the predictive model. RESULTS Cox regression and PSM analysis showed that the prognosis of SDLNM patients was similar to breast cancer patients in stage TnN3cM0 and superior to patients with other oligometastasis (SDLNM vs. TnN3cM0, p = 0.778; SDLNM vs. other oligometastasis: HR 0.767, 95% CI, 0.672-0.875, p < 0.001). A nomogram was established to predict 1-, 3-, and 5-year OS for SDLNM patients. All C-indexes and AUCs were greater than 0.7. Calibration curves implied accurate prediction. For patients receiving mastectomy, postoperative chemotherapy and radiotherapy were significant. CONCLUSIONS Breast cancer with SDLNM has a similar OS and BCSS with locally advanced disease. Comprehensive treatment was associated with better prognosis compared with palliative therapy. We constructed a predictive model for SDLNM breast cancer. It will be necessary to design large-scale prospective trials to confirm our results and validate the predictive model.
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Affiliation(s)
- Hong Lin
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jianxiong Lin
- Department of Hematology and Oncology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yanxuan Wu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Guoxi Liang
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiating Sun
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Liming Chen
- Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Systematic review of synchronous contralateral axillary metastases in breast cancer: really M1 disease? Breast Cancer 2021; 29:9-18. [PMID: 34652689 DOI: 10.1007/s12282-021-01293-2] [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: 06/24/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of the study is to assess and quantify the effect of the appearance of synchronous contralateral axillary on breast cancer survival. Breast cancer with contralateral axillary metastases (CAM) is classified as a metastatic disease. There are few cases reported and a lack of evidence of the significance of CAM when synchronous appearance with a primary tumor and no other site of disease. METHODS A systematic review following PRISMA guidelines to evaluate the prognosis of patients with synchronous CAM without other metastatic diseases comparing with metastatic disease is conducted through a search in PubMed, Embase, Clinical Key, and Cochrane Library databases. We present one case. The median age, follow-up, clinico-pathological characteristics, status of lymph nodes, treatments, and outcomes are analyzed. RESULTS A total of 23 articles (10 case reports and 13 case series) with a total 68 patients, including our case. Median age was 48 years old. Median follow-up was 27 months. Overall survival of the series was 71.4%. Twenty-one of 49 patients reported (36.2%) were alive without disease, fourteen (28.6%) were alive with disease while the rest fourteen (28.6%) died. Inflammatory presentation and ipsilateral axilla status were related to overall survival. CONCLUSIONS Synchronous CAM in breast cancer show better outcomes in terms of overall survival than other metastatic diseases. The absence of comparative studies may not allow definitive conclusions, meanwhile, together with other authors we suggest treatment with curative intention. More studies may lead to consider a modification of TNM system.
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Salih AM, Hammood ZD, Pshtiwan LRA, Kakamad FH, Salih RQ, Ali BS. Intermammary breast cancer; the first reported case. Int J Surg Case Rep 2021; 86:106223. [PMID: 34399237 PMCID: PMC8371224 DOI: 10.1016/j.ijscr.2021.106223] [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: 05/19/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cancer of the breast is the most common cancer among females. The current study aims to report and discuss a rare case of breast cancer in the intermammary region. CASE REPORT A 61-year-old lady presented with intermammary swelling for three months. Ultrasound examination showed a hypoechoic micro lobulated mass with internal vascularity seated on the chest wall. There was pathological lymphnodes in the right axilla. Core needle biopsy suspected invasive ductal carcinoma of no specific type. The patient was referred to an oncology center receiving 21 cycles of radiotherapy and hormonal therapy. DISCUSSION The most common site of the occurrence of breast cancer is the upper outer quadrant (found in one-third of patients), followed by the upper inner quadrant (9.4%)-both lower outer and inner quadrants (5.2%) and rarely in the central portion. Intermammary breast cancer is an infrequent finding. CONCLUSION Although it is extremely rare, breast cancer could occur in the intermammary region. It has the same management strategy as breast cancer.
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Affiliation(s)
- Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Zhair D Hammood
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Lana R A Pshtiwan
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
| | - Rawezh Q Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Bakhan S Ali
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
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Therapeutic options for contralateral axillary lymph node metastasis in breast cancer. Curr Probl Cancer 2021; 45:100706. [PMID: 33468335 DOI: 10.1016/j.currproblcancer.2020.100706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
Contralateral axillary lymph node metastasis (CAM) in breast cancer is rare, and the reason is unclear. CAM may be found at the time of primary breast cancer diagnosis or following primary tumor treatment. CAM staging and treatment methods are controversial. Hence, we summarized the features of CAM patients and explored the therapeutic options. We report the case of an 82-year-old woman with right breast cancer accompanied by CAM. The records of breast cancer patients with CAM in PubMed (January 2000-May 2020) were also reviewed. After undergoing comprehensive treatments (neoadjuvant chemotherapy, surgery, radiotherapy, endocrine therapy, and targeted therapy), no signs of recurrence and metastasis were noted during the 25-month follow-up. Overall, 17 studies (36 patients) were selected for the review, of which 15 had synchronous CAM and 21 had metachronous CAM. Nineteen of 22 patients had histologic grade 3. Forty percent (12/30) had ≥4 positive lymph nodes. Among these 36 patients, 9 had triple-negative breast cancers, and 9 were human epidermal growth factor receptor 2 positive. Among the 30 patients staged, 6 (20%) were in stage I; 7 (23.33%), stage II; and 17 (56.67%), stage III. Two patients received systemic therapy, while one received an unknown treatment. The remaining 33 patients all received local treatment (surgery or radiotherapy). The survival time of synchronous and metachronous CAM patients was 12-72 months with the death rate of 1/7 and 12-144 months with that of 3/12, respectively. CAM may be a regional manifestation rather than a distant metastasis. Comprehensive treatment, including surgery and radiotherapy, may provide better control.
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Cairns C, Greenwalt I, Fan KL, Willey SC. Contralateral axillary sentinel lymph node in breast cancer recurrence. Breast J 2020; 26:1379-1381. [PMID: 32291826 DOI: 10.1111/tbj.13816] [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: 09/12/2019] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
The rare but significant reports of aberrant lymph node drainage outside of the ipsilateral axilla in patients with breast cancer necessitate a review of the staging and treatment strategies for these patients. Current staging modalities continue to describe this phenomenon as a stage IV cancer, which could have profound implications for clinical management. We report a case of a patient with recurrent right breast invasive ductal carcinoma whose preoperative lymphoscintigraphy revealed sentinel lymph node drainage to the contralateral axilla. This discovery subsequently altered surgical planning and her ultimate stage.
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Affiliation(s)
- Cassandra Cairns
- Division of Breast Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Ian Greenwalt
- Division of Breast Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kenneth L Fan
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Valhondo-Rama R, Wakfie-Corieh C, Rodríguez Gallo E, Pérez-Castejón M, Brenes Sánchez J, Herrera de la Muela M, Carreras-Delgado J. Contralateral axillary sentinel lymph node drainage in breast cancer: Controversies and management according to the literature. A case report. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Valhondo-Rama R, Wakfie-Corieh CG, Rodríguez Gallo EA, Pérez-Castejón MJ, Brenes Sánchez JM, Herrera de la Muela M, Carreras-Delgado JL. Contralateral axillary sentinel lymph node drainage in breast cancer: Controversies and management according to the literature. A case report. Rev Esp Med Nucl Imagen Mol 2019; 38:316-319. [PMID: 30723043 DOI: 10.1016/j.remn.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
Abstract
Lymphoscintigraphy in breast cancer usually shows lymphatic drainage to the ipsilateral axilla. Drainage to extraaxillary or contralateral axillary regions is rare and there is still controversy about its management. Due to the significant clinical impact of an accurate staging, a literature research is made based on a case of a patient with recurrence of left breast cancer with contralateral axillary sentinel lymph node detection, without evidence of lymphatic drainage to other locations.
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Affiliation(s)
- R Valhondo-Rama
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España.
| | - C G Wakfie-Corieh
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España
| | | | - M J Pérez-Castejón
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España
| | - J M Brenes Sánchez
- Unidad de Patología Mamaria, Servicio de Ginecología y Obstetricia, Hospital Clínico San Carlos, Madrid, España
| | - M Herrera de la Muela
- Unidad de Patología Mamaria, Servicio de Ginecología y Obstetricia, Hospital Clínico San Carlos, Madrid, España
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Unusual Contralateral Axillary Lymph Node Metastasis in a Second Primary Breast Cancer Detected by FDG PET/CT and Lymphoscintigraphy. Nucl Med Mol Imaging 2017; 51:350-353. [PMID: 29242730 DOI: 10.1007/s13139-017-0485-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022] Open
Abstract
Contralateral metastatic axillary lymph nodes in a patient with breast cancer is a rare condition. Here, we present a 55-year-old woman with a second primary breast cancer. The patient underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for staging work-up. Additionally, preoperative lymphoscintigraphy was performed to detect sentinel lymph nodes. FDG PET/CT demonstrated increased FDG uptake in the left nipple and right axillary lymph nodes. Lymphoscintigraphy identified the right axillary lymph nodes which was consistent with the FDG PET/CT findings. This case emphasizes the usefulness of FDG PET/CT and lymphoscintigraphy for identifying unpredictable contralateral axillary lymph node metastasis from a second primary breast cancer.
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Ayaz S, Gültekin SS, Ayaz ÜY, Dilli A. Initial Fludeoxyglucose (18F) Positron Emission Tomography-Computed Tomography (FDG-PET/CT) Imaging of Breast Cancer - Correlations with the Primary Tumour and Locoregional Metastases. Pol J Radiol 2017; 82:9-16. [PMID: 28105247 PMCID: PMC5238949 DOI: 10.12659/pjr.899358] [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: 04/30/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022] Open
Abstract
BACKROUND We aimed to evaluate initial PET/CT features of primary tumour and locoregional metastatic lymph nodes (LNs) in breast cancer and to look for potential relationships between several parameters from PET/CT. MATERIAL/METHODS Twenty-three women (mean age; 48.66±12.23 years) with a diagnosis of primary invasive ductal carcinoma were included. They underwent PET/CT imaging for the initial tumour staging and had no evidence of distant metastates. Patients were divided into two groups. The LABC (locally advanced breast cancer) group included 17 patients with ipsilateral axillary lymph node (LN) metastases. The Non-LABC group consisted of six patients without LN metastases. PET/CT parameters including tumour size, axillary LN size, SUVmax of ipsilateral axillary LNs (SUVmax-LN), SUVmax of primary tumour (SUVmax-T) and NT ratios (SUVmax-LN/SUVmax-T) were compared between the groups. Correlations between the above-mentioned PET/CT parameters in the LABC group as well as the correlation between tumour size and SUVmax-T within each group were evaluated statistically. RESULTS The mean values of the initial PET/CT parameters in the LABC group were significantly higher than those of the non-LABC group (p<0.05). The correlation between tumour size and SUVmax-T value within both LABC and non-LABC groups was statistically significant (p<0.05). In the LABC group, the correlations between the size and SUVmax-LN values of metastatic axillary LNs, between tumour size and metastatic axillary LN size, between SUVmax-T values and metastatic axillary LN size, between SUVmax-T and SUVmax-LN values, and between tumour size and SUVmax-LN values were all significant (p<0.05). CONCLUSIONS We found significant correlations between PET/CT parameters of the primary tumour and those of metastatic axillary LNs. Patients with LN metastases had relatively larger primary tumours and higher SUVmax values.
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Affiliation(s)
- Sevin Ayaz
- Department of Nuclear Medicine, Mersin State Hospital, Mersin, Turkey
| | - Salih Sinan Gültekin
- Department of Nuclear Medicine, Hacettepe University, Kastamonu School of Medicine and Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ümit Yaşar Ayaz
- Department of Radiology, Mersin Women's and Children's Hospital, Mersin, Turkey
| | - Alper Dilli
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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