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Lam AHK, Co MTH, Kwong A. Rare Breast Cancer Histotypes-A Retrospective Study and Literature Review. J Clin Med 2024; 13:643. [PMID: 38337337 PMCID: PMC10856513 DOI: 10.3390/jcm13030643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
Breast cancer is the most common cancer among women globally and can be classified according to various histological subtypes. Current treatment strategies are typically based on the cancer stage and molecular subtypes. This article aims to address the knowledge gap in the understanding of rare breast cancer. A retrospective study was conducted on 4393 breast cancer patients diagnosed from 1992 to 2012, focusing on five rare subtypes: mucinous, invasive lobular, papillary, mixed invasive and lobular, and pure tubular/cribriform carcinomas. Our analysis, supplemented by a literature review, compared patient characteristics, disease characteristics, and survival outcomes of rare breast cancer patients with invasive carcinoma (not otherwise specified (NOS)). Comparative analysis revealed no significant difference in overall survival rates between these rare cancers and the more common invasive carcinoma (NOS). However, mucinous, papillary, and tubular/cribriform carcinomas demonstrated better disease-specific survival. These subtypes presented with similar characteristics such as early detection, less nodal involvement, more hormonal receptor positivity, and less human epidermal growth factor receptor 2 (HER2) positivity. To conclude, our study demonstrated the diversity in the characteristics and prognosis of rare breast cancer histotypes. Future research should be carried out to investigate histotype-specific management and targeted therapies, given their distinct behavior.
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Affiliation(s)
| | | | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China; (A.H.K.L.); (M.T.H.C.)
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Zhan H, Fineberg S, Podany P, Zeng J, Wang Y, Harigopal M, Singh K. Pathological response in mucinous carcinoma of breast after neoadjuvant therapy - a multi-institutional study. Hum Pathol 2023; 142:15-19. [PMID: 37972873 DOI: 10.1016/j.humpath.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/05/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
Although mucinous carcinoma (MC) is considered a favorable histologic subtype of invasive breast cancer (BC), a subset of MC is managed with neoadjuvant therapy (NAT). The clinical and pathologic features of MC following NAT are not well characterized. The aim of this study is to characterize pathologic response in patients with MC treated with NAT, including neoadjuvant endocrine therapy (NET), neoadjuvant chemotherapy (NCT), and Herceptin-targeted NCT (H-NCT). We conducted a retrospective cohort study of 28 patients with MC who received preoperative adjuvant therapy followed by resection from three institutions between 2010 and 2020. Demographic and clinical information were retrieved from the medical records. Pathologic review of the post NAT resection specimens was performed including tumor grading, tumor size, staging, residual tumor cellularity, estrogen receptor (ER) and HER2 status. Nine (32 %) patients with ER+/HER2- MC received NET, 8 (29 %) ER+/HER2- MC were treated with NCT only and 11 (39 %) HER2+ MC received HER2-targeted NCT (H-NCT). The HER2+ MC patients were younger (45 vs. 64 years; p = 0.006). The HER2+ MC were of higher grade (p = 0.03) and more likely to be multifocal (p = 0.008). Only 2 of 28 (7 %) MC (both HER2+) showed complete pathologic response with residual acellular mucin pools. Persistent mass-forming mucin pools were present in 26 (93 %) cases. The residual tumor cellularity was markedly reduced (≤5 %) in H-NCT treated MC (11/11, 100 %), followed by NET group (6/9, 67 %) and NCT only group (4/8, 50 %) (p = 0.011). Similarly, a higher rate of pathologic response (pCR/RCB-I) was observed in H-NCT (7/11, 64 %), followed by NET group (5/9, 56 %), and NCT only group (1/7, 13 %) (p = 0.053). Post-therapy, all HER2+ MC were smaller than 2 cm and ypT size was significantly smaller in H-NCT group (11/11, 100 %) versus combined NET (5/9, 55 %) and NCT only groups (4/8, 50 %) (p = 0.029). We conclude that ER-/HER2+ and ER+/HER2-mucinous carcinomas of the breast show robust pathological response to neoadjuvant HER2 targeted and endocrine therapy, respectively. Our findings suggest that MC may show good response to endocrine therapy.
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Affiliation(s)
- Haiying Zhan
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA
| | - Susan Fineberg
- Montefiore Medical Center, Department of Pathology, New York, NY, USA
| | - Peter Podany
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA
| | - Jennifer Zeng
- Icahn School of Medicine at Mount Sinai, Department of Pathology, New York, NY, USA
| | - Yihong Wang
- Brown University Rhode Island Hospital, Department of Pathology, RI, USA
| | - Malini Harigopal
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA
| | - Kamaljeet Singh
- Brown University Women and Infants Hospital of Rhode Island, Department of Pathology, RI, USA.
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Li JW, Sheng DL, Chen JG, You C, Liu S, Xu HX, Chang C. Artificial intelligence in breast imaging: potentials and challenges. Phys Med Biol 2023; 68:23TR01. [PMID: 37722385 DOI: 10.1088/1361-6560/acfade] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/18/2023] [Indexed: 09/20/2023]
Abstract
Breast cancer, which is the most common type of malignant tumor among humans, is a leading cause of death in females. Standard treatment strategies, including neoadjuvant chemotherapy, surgery, postoperative chemotherapy, targeted therapy, endocrine therapy, and radiotherapy, are tailored for individual patients. Such personalized therapies have tremendously reduced the threat of breast cancer in females. Furthermore, early imaging screening plays an important role in reducing the treatment cycle and improving breast cancer prognosis. The recent innovative revolution in artificial intelligence (AI) has aided radiologists in the early and accurate diagnosis of breast cancer. In this review, we introduce the necessity of incorporating AI into breast imaging and the applications of AI in mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography/computed tomography based on published articles since 1994. Moreover, the challenges of AI in breast imaging are discussed.
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Affiliation(s)
- Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Dan-Li Sheng
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jian-Gang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, People's Republic of China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Shuai Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, People's Republic of China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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Grażyńska A, Niewiadomska A, Owczarek AJ, Winder M, Hołda J, Zwolińska O, Barczyk-Gutkowska A, Lorek A, Kuźbińska A, Steinhof-Radwańska K. BIRADS 4 - Is it possible to downgrade lesions that do not enhance on recombinant contrast-enhanced mammography images? Eur J Radiol 2023; 167:111062. [PMID: 37643559 DOI: 10.1016/j.ejrad.2023.111062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Analysis of the morphology of lesions classified into the BI-RADS 4 category and assessment of the possibility of downgrade the BI-RADS category in those that did not show enhancement on recombinant contrast-enhanced mammography (CEM) images. METHOD The retrospective, single-center study included 528 patients who underwent a core needle biopsy performed from January 2017 to November 2022 due to a breast lesion classified as BI-RADS 4 on CEM. Patients' electronic records and imaging examinations were reviewed. Individual lesions were classified into the morphological categories of mass, non-mass, and microcalcifications. Sensitivity, specificity, positive as well as negative predictive values were calculated for the whole group and individual morphological categories. The influence of the lesions' diameter on the results was analyzed. RESULTS CEM NPV for the whole group was 93.9% (±95% CI: 90.0-96.4), for mass lesions 100% (±95% CI: 94.5-100), for non-mass lesions 97.8% (±95% CI: 87.0-99.9) and 87.9% (±95% CI: 80.3-93.0) for microcalcifications. Given that 230 out of 383 benign lesions were not contrast-enhancing, 60.1% of unnecessary CNBs would have been correctly avoided. CEM sensitivity for lesions < 20 mm was lower than for lesions ≥ 20 mm and was respectively 86.6% (±95% CI: 76.8-92.8) vs 94.6% (±95% CI: 86.0-98.2), respectively. CONCLUSION CEM is characterized by high sensitivity in the detection of malignant lesions in the case of lesions with mass and non-mass morphology. The high NPV for recombinant images suggests that in the case of these lesions, the lack of enhancement supports the benign nature of the lesion and may lead to a downgrade of the BI-RADS category.
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Affiliation(s)
- Anna Grażyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland.
| | - Agnieszka Niewiadomska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Aleksander J Owczarek
- Department of Pathophysiology, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Jakub Hołda
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland; Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034 Cracow, Poland
| | - Olga Zwolińska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Ceglana 35, 40-514 Katowice, Poland
| | - Aleksandra Kuźbińska
- Department of Pathomorfology, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland
| | - Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 14, 40-752 Katowice, Poland.
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Lei T, Shi YQ, Chen TB. Mammary mucinous cystadenocarcinoma with long-term follow-up: molecular information and literature review. Diagn Pathol 2023; 18:13. [PMID: 36737820 PMCID: PMC9898891 DOI: 10.1186/s13000-023-01302-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mucinous cystadenocarcinoma (MCA) is a very rare form of breast cancer that was first described in 1998. Only 33 cases of primary MCA, including our present case, have been reported thus far. As a consequence, its molecular features, prognosis and treatment regimen are poorly known. Here, we describe a less common presentation of MCA, detail its molecular features, discuss the major differential diagnosis, and provide a brief review of the literature. CASE PRESENTATION A 59-year-old woman presented with a breast lump in which mammography showed a well-defined nodule. Core needle biopsy (CNB) revealed several lesions lined by tall columnar cells with stratification and abundant mucinous secretion; excision was recommended for final diagnosis. The resected specimens showed cavities of different sizes without surrounding myoepithelial cells. The cavities were rich in mucus, and the nuclei were located at the base of the cells, containing intracellular mucus. Immunohistochemical analysis revealed that it was triple-negative breast cancer (TNBC). Next-generation sequencing (NGS) revealed pathogenic mutations in the PIK3CA, KRAS, MAP2K4, RB1, KDR, PKHD1, TERT, and TP53 genes. A diagnosis of MCA was rendered. The patient has been followed up for 108 months to date and showed no signs of recurrence or metastasis. CONCLUSION Our study presents the gene profile of an MCA case with no recurrence or metastatic tendency after 108 months of follow-up, and a review of the literature helps us better understand the clinical, pathologic, and molecular features of this tumor.
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Affiliation(s)
- Ting Lei
- grid.452253.70000 0004 1804 524XDepartment of Pathology, The Third Affiliated Hospital of Soochow University, Ju Qian Street 185, Changzhou, 213003 Jiangsu China
| | - Yong Qiang Shi
- grid.452253.70000 0004 1804 524XDepartment of Pathology, The Third Affiliated Hospital of Soochow University, Ju Qian Street 185, Changzhou, 213003 Jiangsu China
| | - Tong Bing Chen
- grid.452253.70000 0004 1804 524XDepartment of Pathology, The Third Affiliated Hospital of Soochow University, Ju Qian Street 185, Changzhou, 213003 Jiangsu China
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Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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Rongioletti F. New and emerging conditions of acquired cutaneous mucinoses in adults. J Eur Acad Dermatol Venereol 2022; 36:1016-1024. [DOI: 10.1111/jdv.17983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- F. Rongioletti
- Dermatology Clinic IRCCS San Raffaele Scientific Institute Via Olgettina, 60 20132 Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
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