1
|
Alotaibi BS, Alghamdi R, Aljaman S, Hariri RA, Althunayyan LS, AlSenan BF, Alnemer AM. The Accuracy of Breast Cancer Diagnostic Tools. Cureus 2024; 16:e51776. [PMID: 38192524 PMCID: PMC10772305 DOI: 10.7759/cureus.51776] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/10/2024] Open
Abstract
Background Breast cancer (BC) remains a significant health concern, leading to illness and death among women globally. It is essential to detect BC early using imaging techniques that accurately reflect the final pathology, guiding suitable intervention strategies. Objectives This study aimed to evaluate the agreement between radiological findings and histopathological results in BC cases. Methods We conducted a retrospective review of breast core needle biopsies (CNBs) in women over a six-year period (2017-2022) at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The pathological diagnoses were compared with the findings from preceding radiological investigations. We also compared the tumour sizes in the resection specimens with their radiological counterparts. Results A total of 641 cases were included in the study. Ultrasound (US), mammography, and magnetic resonance imaging (MRI) yielded diagnostic accuracies of 85%, 77.9%, and 86.9%, respectively. MRI had the highest sensitivity at 72.2%, while US had the lowest at 61%. MRI provided the best agreement with the final resected tumor size. By contrast, mammography tended to overestimate the size (41.9%), and US most frequently underestimated it (67.7%). The connection between basal-like molecular subtypes and the Breast Imaging Reporting and Data System (BIRADS)-5 classifications was only statistically significant for MRI (p = 0.04). The luminal subtype was more likely to show speculation in mammography. Meanwhile, BIRADS-4 revealed a considerable number of benign pathologies across all the three modalities. Conclusions MRI demonstrated the highest accuracy, sensitivity, specificity, and positive predictive value (PPV) for diagnosing and estimating the tumor size. Mammography outperformed US in terms of sensitivity and yielded the highest negative predictive value (NPV). US, meanwhile, offered superior specificity, PPV, and accuracy. Therefore, combining these diagnostic methods could yield significant benefits.
Collapse
Affiliation(s)
- Batool S Alotaibi
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Rahaf Alghamdi
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Sadeem Aljaman
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Reem A Hariri
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Lama S Althunayyan
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Batool F AlSenan
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Areej M Alnemer
- Pathology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| |
Collapse
|
2
|
Mitchell MC, Pollock J, Downs MB, Stephen D. Metastatic Leptomeningeal Carcinomatosis From Primary Lobular Breast Cancer Found in a Medical School Cadaveric Dissection. Cureus 2023; 15:e44533. [PMID: 37790014 PMCID: PMC10544739 DOI: 10.7759/cureus.44533] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Leptomeningeal carcinomatosis (LC) is an uncommon sequelae of metastatic cancer affecting the pia and arachnoid mater. It has been postulated that recent improvements in cancer patient survival time have increased the frequency of LC and other rare metastatic conditions that patients previously would not have lived long enough to experience. LC carries a universally poor prognosis with a mean survival of between two to four months if treated; however, the recent increase in incidence has allowed for further research into the condition and potential treatments. Options for administering chemotherapy have been limited in the past, but recent developments in surgical chemotherapeutic ports have allowed for intrathecal delivery of drugs like methotrexate without systemic exposure. In fact, innovative delivery systems undergoing clinical trials can deliver these drugs in a metronomic fashion to limit the leukoencephalopathy complications of methotrexate. Primary breast cancer is the most common source of metastatic leptomeningeal lesions, and such a lesion was observed by the authors in the cadaver of a 70-year-old Caucasian female with unspecified breast cancer in a medical school anatomic laboratory. The cause of death was listed as "complication of malignant neoplasm of unspecified site of unspecified female breast." Through this case report, we seek to develop our understanding of this rare metastatic phenomenon and highlight the importance of student cadaveric dissection.
Collapse
Affiliation(s)
- Mary C Mitchell
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - James Pollock
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Mary B Downs
- Anatomy, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - David Stephen
- Pathology, Edward Via College of Osteopathic Medicine, Auburn, USA
| |
Collapse
|
3
|
Almahari SAI, Chandran N, Maki RJ. Deceptive Triple-Negative Breast Cancer of Intermediate Grade: A Case of Rare Microglandular Adenosis-Associated Carcinoma. Cureus 2023; 15:e39531. [PMID: 37250605 PMCID: PMC10217789 DOI: 10.7759/cureus.39531] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 05/31/2023] Open
Abstract
Breast cancer is the most common cancer among women and the leading cause of cancer-related deaths globally. Ductal carcinoma of no special type is the most prevalent, followed by lobular carcinoma. Finding a triple-negative breast cancer of intermediate grade on core biopsies should raise the possibility of dealing with one of the rare subtypes such as microglandular adenosis (MGA)-associated carcinoma. Here, we present a case of a 40-year-old female, who presented with bilateral breast masses, in which one of them was a high-grade carcinoma and the other turned out to be an MGA-associated carcinoma, which was misdiagnosed initially on the core biopsy as a grade II triple-negative ductal carcinoma of no special type. Such diagnosis is challenging to pathologists, especially on small biopsies where the full morphological spectrum is not evident.
Collapse
Affiliation(s)
- Sayed Ali I Almahari
- Department of Pathology: Anatomical Pathology, Salmaniya Medical Complex, Manama, BHR
| | - Nisha Chandran
- Department of Pathology: Anatomical Pathology, Salmaniya Medical Complex, Manama, BHR
| | - Reem J Maki
- Department of Radiology, Salmaniya Medical Complex, Manama, BHR
| |
Collapse
|
4
|
Li B, Nguyen J, Williams CA, Cardenas K, Pidhorecky I. Rare Papillary Breast Carcinoma Incidentally Discovered After Trauma-Induced Hematoma. Cureus 2021; 13:e18215. [PMID: 34722027 PMCID: PMC8544644 DOI: 10.7759/cureus.18215] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/23/2021] [Indexed: 12/03/2022] Open
Abstract
Papillary carcinoma of the breast is rare, comprising only 0.5% incidence of all breast cancers. Clinically the disease presents in postmenopausal women as a painless breast lump with possible bloody nipple discharge. Prognosis is favorable due to its slow growth. We present a 61-year-old woman incidentally diagnosed with papillary breast carcinoma after presenting with a trauma-induced hematoma of the right breast. The patient presented to our surgery oncology clinic for persistent right breast swelling secondary to a fall, despite initial incision and drainage (I&D) six weeks prior. She had no history of breast cancer. On presentation, her right breast was distended demonstrating an approximately 20cm ill-defined solid mass with skin changes consistent with a tense hematoma. CT scan demonstrated a large complex cystic and solid breast mass measuring 15.2cmx11.8cmx15.2cm with irregular peripheral solid hyperdense polypoid components. She then underwent a right breast incisional biopsy and hematoma evacuation. Frozen sections of the mass outer cavity wall and papillary projections were consistent with encapsulated papillary carcinoma (EPC). The patient was lost to follow-up and did not obtain definitive treatment. Breast cancer rarely presents as a breast hematoma. However, as in this case, if the hematoma fails to resolve, further investigation is warranted. The prognosis of EPC is excellent when identified and treated appropriately.
Collapse
Affiliation(s)
- Becky Li
- Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Jackie Nguyen
- Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Caitlin A Williams
- Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | | | - Ihor Pidhorecky
- Surgical Oncology, Westside Regional Medical Center, Plantation, USA
| |
Collapse
|
5
|
Zahid IG, Kummarapurugu S, Alrefai S. Xanthogranulomatous Breast Mass: An Unusual Presentation. Cureus 2021; 13:e17973. [PMID: 34660155 PMCID: PMC8516024 DOI: 10.7759/cureus.17973] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Xanthogranulomatous inflammatory reactions are benign inflammatory processes characterized by aggregating lipid-laden foamy macrophages. Although cases have been reported in different organ systems, these rare reactions predominantly occur in the kidney and gallbladder. We present a 92-year-old female who noticed a palpable, tender mass in the lower inner quadrant of her right breast with no skin changes. She was referred to surgery by her primary care physician on suspicion of malignancy and further evaluation. Ultrasound-guided biopsy, ordered by the primary care provider, revealed a suspicious high-grade malignant neoplasm of uncertain origin. Pathological findings include the presence of an unusual population of malignant epithelioid cells with a striking xanthogranulomatous reaction, along with numerous Touton-like histiocytes. These findings are comparable in morphology to a recently reported xanthogranulomatous epithelial tumor. Given the lack of history of breast carcinoma in this patient as well as the lack of immunohistochemical studies suggesting breast carcinoma, treatment involved continuing standard of care for an unusual high-grade sarcoma via lumpectomy. A positron emission tomography (PET) scan was ordered to ensure there was no spread or alternate origins of the cancer tissue. This case report brings to light the findings of a probable xanthogranulomatous tumor in breast tissue, an exceptionally rare phenomenon in breast cancer, especially in the elderly population. Due to the rarity of xanthogranulomatous tumors in the breast, prognosis and standardized treatment have yet to be established.
Collapse
Affiliation(s)
- Ibtesam G Zahid
- General Surgery, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | | | - Sameer Alrefai
- General Surgery, Sentara Halifax Regional Hospital, South Boston, USA
| |
Collapse
|
6
|
Matute G, Barcenas L, Bautista C, Restrepo Ramirez CA, Llinas Quintero N. Tall Cell Carcinoma With Reversed Polarity of the Breast. Cureus 2021; 13:e16814. [PMID: 34522474 PMCID: PMC8424973 DOI: 10.7759/cureus.16814] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Tall cell carcinoma with reversed polarity (TCCRP) of the breast is a rare entity with low potential for malignancy that exhibits some morphological similarities to the tall cell variant of papillary thyroid carcinoma. Immunohistochemical and molecular studies help establish the mammary origin of this neoplasm. Here, we describe the case of a 63-year-old woman with a finding of a nodular lesion during a screening mammogram, whose morphological findings and immunohistochemical studies confirmed the diagnosis of papillary high cell carcinoma with the reverse polarity of the mammary gland.
Collapse
Affiliation(s)
| | - Linda Barcenas
- Pathology and Laboratory Medicine, National University of Colombia, Bogotá, COL
| | - Carolina Bautista
- Pathology, Fundación Universitaria Ciencias de la Salud, Bogotá, COL
| | | | | |
Collapse
|
7
|
Masab M, Gross A, Flanagan M, Goldberg R, Malla M. Neuroendocrine Neoplasm of the Breast Presenting as a Liver Metastasis: A Rare Diagnostic Challenge. Cureus 2021; 13:e16860. [PMID: 34513437 PMCID: PMC8413109 DOI: 10.7759/cureus.16860] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
We present a case of a 58-year-old female who presented initially to an outside institution with abdominal pain and was diagnosed on liver biopsy with a well-differentiated neuroendocrine tumor of an unknown primary source. She was referred to our academic institution for a second opinion after disease progression on the initial chemotherapy regimen. Through additional evaluation, diagnostics, and multi-disciplinary tumor board discussion she was diagnosed with metastases from a well-differentiated neuroendocrine neoplasm of the breast (NENB). Consequently, her treatment plan was modified leading to significant clinical and radiological improvement.
Collapse
Affiliation(s)
- Muhammad Masab
- Hematology and Medical Oncology, West Virginia University, Morgantown, USA
| | - Alexander Gross
- Pathology and Laboratory Medicine, West Virginia University, Morgantown, USA
| | - Melina Flanagan
- Pathology and Laboratory Medicine, West Virginia University, Morgantown, USA
| | - Richard Goldberg
- Hematology and Medical Oncology, West Virginia University, Morgantown, USA
| | - Midhun Malla
- Hematology and Medical Oncology, West Virginia University, Morgantown, USA
| |
Collapse
|
8
|
Abstract
Since idiopathic granulomatous lobular mastitis, also known as idiopathic granulomatous mastitis or granulomatous lobulitis, was first described by Kessler and Wolloch in 1972, no consensus on the ideal and definitive treatment for this phenomenon has been reached thus far. Idiopathic granulomatous lobular mastitis mostly frequently observed in women of childbearing age within a few years of pregnancy with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. This entity, per se, is a rare, benign, chronic inflammatory breast condition of unknown aetiology mimicking two common breast disorders. The first is breast inflammations or infection, such as cystic neutrophilic granulomatous mastitis; granulomatous mastitis due to Corynebacterium;other infections with granulomas, mycobacteria, fungi, cat scratch disease, and Brucella; granulomatosis with polyangiitis (Wegener's granulomatosis); sarcoidosis; and squamous metaplasia of lactiferous ducts. The second is breast carcinoma in some challenging cases. Of note, no consensus, per se, has been declared on its therapeutic management. The following vignette case described in this report involves idiopathic granulomatous lobular mastitis imitating breast carcinoma. It is important to note that, the aetiology of idiopathic granulomatous lobular mastitis is unknown, its diagnosis is difficult, and physicians should be vigilant and aware of this condition in order of abstaining from an overtreatment for malignancy or overlooking a true malignancy.
Collapse
Affiliation(s)
- Ismail Aydin
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Tugrul Kesicioglu
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Selahattin Vural
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine Surgery, General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Kivanc Yilmaz
- Pathology, Ministry of Health-Giresun University Education and Research Hospital, Giresun, TUR
| | - Demet Sengul
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
| |
Collapse
|
9
|
Cotarelo CL, Schad A, Kirkpatrick CJ, Sleeman JP, Springer E, Schmidt M, Thaler S. Detection of cellular senescence within human invasive breast carcinomas distinguishes different breast tumor subtypes. Oncotarget 2016; 7:74846-74859. [PMID: 27713152 PMCID: PMC5342706 DOI: 10.18632/oncotarget.12432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 09/12/2016] [Indexed: 01/07/2023] Open
Abstract
Oncogene-induced senescence is thought to act as a barrier to tumorigenesis by arresting cells at risk of malignant transformation. Nevertheless, numerous findings suggest that senescent cells may conversely promote tumor progression through the development of the senescence-associated secretome they produce. It is likely that the composition and the physiological consequences mediated by the senescence secretome are dependent on the oncogenes that trigger the senescence program. Breast cancer represents a heterogenous disease that can be divided into breast cancer subtypes due to different subsets of genetic and epigenetic abnormalities. As tumor initiation and progression of these breast cancer subtypes is triggered by diverse oncogenic stimuli, differences in the senescence secretomes within breast tumors might be responsible for tumor initiation, progression, metastasis and therapeutic response. Many studies have addressed the role of senescence as a barrier to tumor progression using murine xenograft models. However, few investigations have been performed to elucidate the degree to which senescent tumor cells are present within untreated human tumors, and if present, whether these senescent tumor cells may play a role in disease progression. In the present study we analysed the appearance of senescent cells within invasive breast cancers. Detection of cellular senescence by the use of SAβ-galactosidase (SAβ-gal) staining within invasive breast carcinoms from 129 untreated patients revealed differences in the amount of SAβ-gal+ tumor cells between breast cancer subtypes. The highest percentages of SAβ-gal+ tumor cells were found in HER2-positive and luminal A breast carcinomas whereas triple negative tumors showed either little or no positivity.
Collapse
Affiliation(s)
- Cristina L. Cotarelo
- Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Jonathan P. Sleeman
- Centre for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- KIT Campus Nord, Institute for Toxicology and Genetics, Karlsruhe, Germany
| | - Erik Springer
- Institute of Pathology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Sonja Thaler
- Centre for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|