Search

Objective Quantitative analysis of tumor-infiltrating lymphocytes (TILs) is currently considered as a prognostic factor in several malignant tumors. The aim of our study was to assess the prognostic value of TILs in breast cancers and its association with other clinicopathological prognostic factors in non-specific type (NST) breast carcinoma in Tunisian population. Methods Retrospective study included 53 women with NST breast carcinoma. The data were collected over a period of 13 months with a follow-up of 40 months for all the patients. The TILs were evaluated according to the 2014 recommendations of the international working group on TILs. Results TILs level was between 3% and 60% with mean of 21%. Ten patients had lymphocyte predominant breast cancer (LPBC). Statistical analysis had shown that the TILs level ≤50% was associated with the presence of vascular emboli and the absence of HER2 amplification. Inflammatory-type carcinoma and HER2 amplification significantly worsened OS. Presence of vascular emboli, lymph node metastases, inflammatory type of carcinoma, TILs ≤50%, and absence of estrogen receptors (ER) were associated with reduced RFS . In multivariate analysis, the presence of vascular emboli was an independent factor for OS. TILs ≤50%, inflammatory type of carcinoma and presence of vascular emboli were independent risk factors for RFS. Conclusion This Tunisian pilot study showed higher level of TILs in NST breast carcinomas is associated with improved RFS. The therapeutic implications will benefit from multiple research studies including ours on the predictive value of TILs for neoadjuvant or adjuvant treatment.

Breast cancer is the most common cancer among women in the USA and rarely metastasises to the gastric wall. We present a case of a 69-year-old woman with medical history of stage II-B breast cancer who presented with epigastric abdominal pain and black tarry stools. CT scan of the abdomen showed moderate gastric wall thickening and ascites. The patient underwent an esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) for a fine-needle biopsy, which was negative for malignancy. Based on her presentation, we kept a high index of suspicion for peritoneal carcinomatosis and malignancy. The patient underwent laparoscopic wedge resection of the gastric wall with biopsies of gastric wall and peritoneum. Both biopsies confirmed the diagnosis of metastatic invasive lobular breast carcinoma. Our case highlights the importance of diagnostic laparoscopy and EUS in the setting of negative EGD biopsy results with a high suspicion of breast cancer metastasis to gastric wall.

Introduction Breast carcinoma (BC) is one of the most common cancer-related mortality among women worldwide. S100A9 and S100A8 are calcium-binding proteins involved in BC metastasis. Toll-like receptors (TLRs) are membrane-bound proteins that play a vital role in immune systems and carcinogenesis through inflammatory cytokines. Objectives We aimed to evaluate of S100A8, S100A9 and TLR5 in breast carcinoma by IHC, their gene expression by PCR and investigate their correlation with clinicopathological characters and hormone status. Materials and methods This study was done in Biochemistry & Molecular Biology and Pathology Departments, Zagazig University, Egypt. Biopsy was taken from 72 patients with invasive breast carcinoma cases admitted to Surgery Department, Zagazig University, between January 2018 and January 2021. 72 breast biopsies were obtained from adjacent normal breast (as a control). IHC, gene expression by q real-time PCR using S100A8, S100A9 and TRL5. Results Positive S100A8, S100A9, TLR5 were 81.9%, 76.4%, 86.1% respectively with statistically significant association between advanced stage, presence of lymph node metastasis, ER.PR status and HER2 negative expression. Conclusiones Based on our findings, we postulated that S100A8, S100A9, TLR5 play an important role in progression of BC and can be used as novel molecular targets for earlier BC detection and prediction for future therapies in breast carcinoma.

Paget's disease (PD) of the male breast represents less than 2% of male breast cancer. The diagnosis usually delays about 8 months, until it is decided to biopsy the nipple–areola complex lesion. Immunohistochemical techniques help us to differentiate it from other diseases that affect the nipple–areola complex. Most of the patients present an underlying breast carcinoma, which conditions the prognosis. Mastectomy with sentinel lymph node biopsy is the initial treatment in clinically node-negative patients. Two systematic reviews have collected 57 cases of PD of the breast in men published up to 2016. We report an unusual case of mammary PD in a male patient with cytokeratin 7-negative variant.

Background: Breast carcinoma is classified in keeping with its morphologic features. As regards the WHO classification, the histopathological kinds of the breast carcinoma; ductal carcinomas, lobular carcinomas, and uncommon kinds, these are associated with particular imaging features, primarily based on every kind. Additionally, predictive biologic markers along with estrogen, progesterone receptors, HER2 receptor status, and Ki-67 may be suitable to sub-classify breast carcinoma into the intrinsic subtypes primarily based totally on gene expression profiling into: Luminal A, Luminal B, HER2+, and Triple Negative. Correlation among the imaging and the molecular subtypes has discovered an enormously circumscribed lesions with posterior acoustic enhancement without calcification inside the triple negative breast cancer subtype, microcalcifications are seen with the HER2+ subtype, but speculated lesions of irregular margin and posterior acoustic shadow with the luminal A and B subtypes, MRI is a longtime supplemental method to mammography and ultrasonography for the assessment of breast lesions. Diffusion-weighted MR imaging (DWI) has lately been incorporated into the breast MRI, moreover dynamic contrast enhanced MRI (DCE-MRI). Conclusion: Understanding medical collaboration of molecular subtypes and imaging features can assist the radiologist to help the clinician to adjust treatment consistent with the patient condition and tumor characteristics.

Summary Background Mastectomy may be needed in the context of previous radiotherapy in cases of breast carcinoma following mantle field radiotherapy for Hodgkin lymphoma or in cases of local relapse or second primary tumours after breast conserving therapy including whole-breast irradiation (BCT). The outcome of combined skin-sparing mastectomy and immediate implant-based breast reconstruction (SSM-IIBR) has been reported to be unfavourable in these cases. Purpose To compare the outcome of SSM-IIBR after mantle field radiotherapy to that after BCT and to compare both to the outcome observed in non-irradiated breasts. Methodology The prevalences of short-term events, device loss, long-term corrections and secondary reconstructions, and reversion to autologous tissue techniques of 42 SSM-IIBRs performed after mantle field irradiation were compared to those of 47 salvage SSM-IIBRs following BCT. Both outcomes were compared to the outcome in the contralateral, non-irradiated breast of the subgroup of 23 women in the BCT group. Results The groups were comparable in terms of patient- and procedure-related risk factors, except for time lapse after previous therapy, intraoperative device weight, and the fraction of immediate use of a definitive implant. The outcome of SSM-IIBR after mantle field irradiation significantly differs favourably from that after BCT. It matches the outcome observed in non-irradiated breasts. Conclusion Skin-sparing mastectomy combined with immediate implant-based breast reconstruction is a fully justifiable option for women who previously underwent mantle field irradiation for Hodgkin lymphoma. We feel that the unfavourable outcome observed in women who previously underwent BCT necessitates an alternative reconstructive modality.

Background and Objectives: Breast carcinoma, the most common malignant tumor and the leading cause of cancer death in women, affects Iranian women at least one decade earlier. Lymphatic vessel invasion (LVI) is one of the most important prognostic factors in breast carcinoma. The aim of this study was to compare the results of detecting lymphatic invasion in immunohistochemistry (IHC) method with routine histologic evaluation. Materials and Methods: A total of 116 breast cancer specimens were evaluated. IHC staining for D2–40 marker was performed on paraffin-embedded blocks of tumor samples to detect LVI. Results: Sensitivity, specificity, positive, and negative predictive values of H and E staining for detection of the lymphatic invasion were 41%, 66%, 54.8%, and 53.5%, respectively. Kappa coefficient between H and E and D2–40 stainings was 0.078. The most common sites of lymphatic invasions were intratumoral area and tumor periphery. Conclusions: It seems that D2–40 staining is necessary for accurate diagnosis of LVI in breast cancer. Furthermore, evaluation of intratumoral area and tumor periphery can probably increase the chance of finding lymphatic invasion.

BACKGROUND/AIM Paget?s disease (PD) of the breast is a very rare presentation of breast malignancy, accounting for 1?3% of all primary breast tumors. We aimed to evaluate and compare the clinicopathological featuresand clinical outcome of PD accompanied by in situ carcinoma and invasive cancer. MATERIALS AND METHODS We used the archive of our pathology laboratory retrospectively for age, gender, history of surgery, histopathological findings, treatment modalities and follow-up information. We used the Kaplan-Meier method for survival analysis. RESULTS There were 46 female patients diagnosed with PD. In 39 (84.7%) patients invasive carcinoma accompanied PD, while 7 (15.3%) patients had ductal carcinoma in situ (DCIS). The median age at diagnosis was 53.5 years. The median follow-up period was 47 months. Of the 39 invasive carcinoma 10 (25.6%) died during the follow-up period. Invasive ductal carcinoma group had a mean overall survival of rate of 57.8 ± 6.6 months. According to univariate analysis only the tumor type was found to impact overall survival (p < 0.001) Conclusions: The current study displayed the tumor type as the only parameter affecting overall survival in the invasive carcinoma group. Although it was not statistically significant, breast cancers accompanied by PD were found to be predominantly advanced stage tumors, high grade, hormon receptor negative and HER2 positive. Key words: Paget?s disease, breast carcinoma, pathology, molecular subtype, immunohistochemistry.

Breast metastases are uncommon findings compared to primary breast cancer and in particular bilateral secondary breast lesions from neuroendocrine tumor (NET)s are extremely rare with just less over 13 cases described in literature. We reported herewith the case of a 54-year-old woman who presented to our Breast Unit after noticing multiple, mobile, bilateral breast lumps. Imaging studies confirmed the presence of multiple, circumscribed, bilateral breast masses with slightly spiculated margins, classified as suspicious for malignancy (BI-RADS 4). A tru-cut biopsy was carried out on the largest lesion of each side and histopathologic and immunohistochemistry examination was consistent with metastases from pancreatic neuroendocrine tumor (PNET). Total-body CT revealed the presence of a mass located in the pancreatic body - tail with associated abdominal lymphadenopathies and multiple secondary nodules in bilateral breast and in the liver. Stage IV disease was diagnosed, patient did not undergo surgery and started LAR – octreotide therapy. Although rare, breast metastases from NETs represent an important diagnostic challenge for practitioners because of the difficulty to differentiate from a primary breast carcinoma or even from benign breast lesions. Clinicians should be aware of the possibility of bilateral breast metastases in differential diagnosis of breast lesions in order to ensure the correct diagnosis and the most appropriate management of these patients.

This study explored human papillomavirus (HPV) amplification in breast benign and malignant lesions by chromogenic in situ hybridization (CISH) and the concordance of p16 expression by immunohistochemistry.The presence of HPV6/11 and HPV16/18 in 33 cases of intraductal papilloma, 34 cases of ductal carcinoma in situ (DCIS), and 56 cases of invasive breast carcinoma (IBC) was evaluated using matched-background breast parenchyma and breast reduction as control groups. Association with clinicopathologic factors including prognosis was assessed.HPV 6/11 was observed in 0 cases (0%) of breast reduction, one case (3%) of intraductal papilloma, 11 cases (32.4%) of DCIS, and eight cases (14.3%) of IBC. HPV 16/18 was detected in three cases of (9.1%) breast reduction, six cases (18.8%) of intraductal papillomas, 14 cases (41.2%) of DCIS, and 25 cases (44.6%) of IBC. There was no difference in the HPV status between intraductal papilloma and breast reduction. HPV amplification in intraductal papilloma did not associate with developing atypia or carcinoma after long-term follow-up. However, HPV 6/11 and HPV 16/18 amplification was significantly higher in both DCIS and IBC when compared with breast reduction (P.05). Compared with background breast parenchyma, HPV 16/18 amplification was significantly higher in both DCIS and IBC (P = .003 and P = .013, respectively). No correlation between p16 immunohistochemical staining and either of the HPV CISH testing was found (P.05).HPV infection was detected in both breast lesions and background parenchyma. HPV infection may play a role in the pathogenesis of breast cancer but is not associated with intraductal papilloma. Immunohistochemical stain for p16 is not a good surrogate marker for HPV infection in breast lesions.

Two vascular endothelial growth factor (VEGF) receptors, FLT-1 and KDR, are expressed preferentially in proliferating endothelium. There is increasing evidence that recombinant, soluble VEGF receptor domains interfering with VEGF signaling may inhibit in vivo neoangiogenesis, tumor growth and metastatic spread. We hypothesized that a soluble form of FLT-1 receptor (sFLT-1) could inhibit the growth of pre-established tumors via an anti-angiogenic mechanism. A replication-deficient adenovirus (Ad) vector carrying the sflt-1 cDNA (Adsflt) was used to overexpress the sFLT-1 receptor in a breast cancer animal model. MCF-7 cells, which produce VEGF, were used to establish solid tumors in the mammary fat pads of female nude mice. After six weeks tumors were injected either with Adsflt, or a negative control virus (AdCMV.βgal). After six months, average tumor volume in the Adsflt-infected group (33 ± 22 mm3) was decreased by 91% relative to that of the negative control group (388 ± 94 mm3; Psflt-infected tumors exhibited complete regression. The vascular density in Adsflt-infected tumors was reduced by 50% relative to that of negative controls (Psflt–infected tumors were preceded by apoptosis of tumor vascular endothelial cells. Mice treated with Adsflt intratumorally showed no delay in the healing of cutaneous wounds, providing preliminary evidence that Ad-mediated sFLT-1 overexpression may be an effective anti-angiogenic therapy for cancer without the risk of systemic anti-angiogenic effects.

We present a 45-year-old woman with metastatic breast disease who initially presented with progressive proptosis of her right eye causing limited motility, diplopia and eye pain. MRI done showed an avidly enhancing right sphenoorbital mass causing displacement in the lateral and superior recti muscles with lysis and infiltration of the greater sphenoid wing and lateral orbital wall. The patient underwent surgery resulting in immediate relief of proptosis and resolution of symptoms. Although surgery is not recommended for orbital metastasis as it is not curative, it should be considered as a treatment option as it can provide relief to patients and improve their quality of life.

Background Arginine depletion interferes with pyrimidine metabolism and DNA damage repair pathways. Preclinical data demonstrated that depletion of arginine by PEGylated arginine deiminase (ADI‐PEG 20) enhanced liposomal doxorubicin (PLD) cytotoxicity in cancer cells with argininosuccinate synthase 1 (ASS1) deficiency. The objective of this study was to assess safety and tolerability of ADI‐PEG 20 and PLD in patients with metastatic solid tumors. Methods Patients with advanced ASS1‐deficient solid tumors were enrolled in this phase 1 trial of ADI‐PEG 20 and PLD following a 3 + 3 design. Eligible patients were given intravenous PLD biweekly and intramuscular (IM) ADI‐PEG 20 weekly. Toxicity and efficacy were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0) and Response Evaluation Criteria in Solid Tumors (version 1.1), respectively. Results Of 15 enrolled patients, 9 had metastatic HER2‐negative breast carcinoma. We observed no dose‐limiting toxicities or treatment‐related deaths. One patient safely received 880 mg/m2 PLD in this study and 240 mg/m2 doxorubicin previously. Treatment led to stable disease in 9 patients and was associated with a median progression‐free survival time of 3.95 months in 15 patients. Throughout the duration of treatment, decreased arginine and increased citrulline levels in peripheral blood remained significant in a majority of patients. We detected no induction of anti‐ADI‐PEG 20 antibodies by week 8 in one third of patients. Conclusion Concurrent IM injection of ADI‐PEG 20 at 36 mg/m2 weekly and intravenous infusion of PLD at 20 mg/m2 biweekly had an acceptable safety profile in patients with advanced ASS1‐deficient solid tumors. Further evaluation of this combination is under discussion., This combination therapy with ADI‐PEG 20 and Doxil had a reversible and manageable toxicity profile, and patients tolerated the treatment. Tumor shrinkage and prolonged duration of therapy were observed in several patients.

Chronic myeloid leukemia is an insidiously progressive condition and comparatively rare type of blood cell malignancy that begins in the bone marrow. Chronic myeloid leukemia typically affects adult population and is documented to be caused by chromosomal mutation that usually occurs spontaneously. Chronic myeloid leukemia is more common in males than in females (male: female ratio of 1.4:1) and appears more commonly in the elderly with a median age at diagnosis of 65 years [1] Exposure to ionising radiation is one of the risk factors, based on a 50 fold higher incidence of CML in Hiroshima and Nagasaki nuclear bombing survivors [1] The rate of CML in these individuals seems to reach at its peak about 10 years after the exposure [1]. Carcinoma breast on the other hand is one of the most common causes of death in middle aged women in western countries. There are numerous factors contributing as its etiological factors such as age, gender, diet, endocrinal factors, previous radiation exposure, genetic factors and geographical factors. We present a case report of a 44 old female who came to Acharya Vinoba Bhave Rural Hospital (Datta Meghe Institute of Medical Sciences and Research), with presenting complaint of lump in the left breast since 2 days and abdominal mass for 1 month. On investigations, patient was diagnosed with a rare case of chronic myeloid leukemia on the complete blood count and peripheral smear and the lump in the left breast also revealed invasive ductal carcinoma of the left breast.

Although breast cancer and endometrial cancer are two frequent female cancers, finding synchronous primary cancers in the same patient is a comparatively uncommon occurrence. We present the case of a Libyan woman who developed synchronous breast cancer, endometrial cancer, and small lymphocytic lymphoma. For the previous six months, a 49-year-old female patient had a right breast mass. An ultrasound scan revealed an uneven doubtful growth in the right breast as well as swollen of the axillary lymph nodes. After a wide local excision, histopathology revealed that the patient had invasive ductal carcinoma of the breast with a positive resection margin, and he was admitted to the Surgery Department. No distal metastasis was seen on a computed tomography (CT) scan of the chest, abdomen, or pelvis, so the patient had a right mastectomy and axillary clearance. Residual invasive ductal carcinoma was found on histopathology and immunohistochemistry with positivity for the estrogen receptor and the progesterone receptor. Small lymphocytic lymphoma (SLL) affected the axillary lymph nodes, affirmed by immunohistochemical staining positive for CD20, CD5, CD23 and BCL-2 while negative for CD3 and Cyclin D1. Resection margins were free. Second cancers are characterized by being linked to SCL, and some researchers have described that the risk of second cancers is elevated in SCL patients. We represent a combined case of synchronous primary SCL with breast cancer and endometrial cancer in a woman which is a rare occurrence.

Item does not contain fulltext The convergence of digital pathology and computer vision is increasingly enabling computers to perform tasks performed by humans. As a result, artificial intelligence (AI) is having an astoundingly positive effect on the field of pathology, including breast pathology. Research using machine learning and the development of algorithms that learn patterns from labeled digital data based on "deep learning" neural networks and feature-engineered approaches to analyze histology images have recently provided promising results. Thus far, image analysis and more complex AI-based tools have demonstrated excellent success performing tasks such as the quantification of breast biomarkers and Ki67, mitosis detection, lymph node metastasis recognition, tissue segmentation for diagnosing breast carcinoma, prognostication, computational assessment of tumor-infiltrating lymphocytes, and prediction of molecular expression as well as treatment response and benefit of therapy from routine H&E images. This review critically examines the literature regarding these applications of AI in the area of breast pathology.

Aim & Objectives: To study the MRM specimens for size, grade of the tumor, LVI and LN metastases and the ER/PR receptors of the tumor. To study the association of ER/PR status with the above mentioned prognostic parameters. Materials and Methods: This three-year study includes 72 histopathologically confirmed cases of carcinoma breast. The tumor type, grade, LNM, LVE were reported on H & E. The ER-PR study was done of all 72 cases. The tumor size, grade, LNM, LVE were correlated with receptor status. Observation: Out of 72 cases majority (53%) of cases were in 41-50 years of age group, and tumor size was between 2-4 cm in (54.16%) cases; majority were of grade II carcinoma (60%) of which 59% were ER-PR positive. Out of 46 cases with negative LNM and LVE, 30 cases (65%) were ER-PR positive. Conclusion: In our observation there is no association between higher histological grade and ER-PR status. No obvious correlation with tumor size was noted. But increase in tumor size could also be a poor predictor of ER-PR status. LNM, LVE is poor predictor of ER-PR status. Keywords: Breast carcinoma, Estrogen and progesterone receptor.

In females breast carcinoma is the most common cancer worldwide. Globally, 2.3 million women were diagnosed and 685 000 deaths due to breast cancer were reported in year 2020. Even in the era of immunohistochemistry (IHC) and molecular studies, the aggressive nature of the breast cancer can be determined by its histological type, grade, nodal status, and metastasis. Mucinous carcinoma (MC) is a rare variant of invasive breast cancer accounting for 1-7%. It is represented by the presence of large extracellular mucin pools. Based on the mucin content two main subtypes are identified: Pure Mucinous Carcinoma (PMC) and Mixed Mucinous Carcinoma (MMC). Pure Mucinous Carcinoma (PMC) is localized in most of the cases, whereas the mixed forms tend to metastasize to lymph nodes. Hence the mixed forms often require an axillary dissection during surgery. We are presenting a case of 70 year old female who presented with the complaints of lump in the right breast since 2 months and on ultrasound work up a score of BIRADS V was given. She underwent right modified mastectomy with right axillary dissection and was diagnosed as mixed type of mucinous adenocarcinoma breast by histopathological examination. It was confirmed by IHC which showed positivity for ER, PR & Synaptophysin and negativity for Her2neu. Prognostically MC is better compared to other variants of invasive ductal carcinoma as they respond to hormone therapy. Keywords: Mucinous carcinoma, Mixed type, Breast carcinoma, Neuroendocrine differentiation, Capella type B.

Introduction: Breast carcinoma is the most common malignancy in females and is a leading cause of death. Treatment depends upon various pathological and prognostic markers like lymph node status, size, type and grade of the tumour which influences the outcome of breast cancer. Markers like Ki-67 and p53 have been studied extensively and their roles in breast cancer are yet to be established. We evaluated the expression of Ki67 and P53 in breast cancer and their association with other clinico-pathological factors was studied. Materials and Methods: Ki67 and P53 expression was assessed in 60 breast cancer cases admitted to our hospital over a period of one year. Association with other prognostic parameters was evaluated. Statistical analysis was done by Chi square test and a p value of Results: 43.33% cases had low proliferative Ki-67 score whereas 56.67% of the cases were highly proliferative. p53 expression was seen in 41.66% cases. Ki-67 and p53 expression were not significantly related to age, menopausal status, and tumour size whereas a significant correlation was seen with positive axillary lymph node status, high histological grade, negative hormone receptor status (ER, PR) and positive HER2/neu expression. Significant association was seen between Ki-67 and p53 expression. Conclusion: Ki67 and P53 may be considered as a valuable biomarker in breast cancer patients which can help in planning treatment strategies. Keywords: Breast cancer, Clinicopathological parameters, Ki 67, P53.

Introduction Cancer immunotherapy targeting the programmed cell death ligand 1 (PD-L1) and programmed cell death-1 (PD-1) axis has revolutionized cancer therapy. PD-L1 also serves as a predictive marker for such therapy. To assess the potential of such therapy in any cancer, the positivity of PD-1 and PD-L1 in such cancers needs to be assessed. However, such studies for breast cancer are lacking in South Asia. We aimed to estimate the positivity of PD-L1 and PD-1 receptors in breast cancer and its various clinicopathological groups in our patient population. Materials and Methods We studied the immunoexpression of PD-1 and PD-L1 in 103 histologically proven invasive carcinoma breast cases from October 2018 to April 2019. The percent positivity of PD-1 and PD-L1 with 95% confidence intervals (CI) was estimated for all the cases as well as groups defined by stage, grade, molecular subtype, hormone receptor status, Ki-67, and age. Results PD-1 positivity was seen in 72 (69.9%) cases (95% CI: 60.1–78.6). PD-L1 immunoexpression was seen in 61 (59.2%) cases (95% CI: 49.1–68.8) in immune cells and in 39 (37.9%) cases (95% CI: 28.5–50.0) in tumor cells. No significant association was found between PD-1, PD-L1 and age, overall clinical stage, grade, size, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67. Moderate-to-high PD-1 and PD-L1 immunopositivity was seen in all subtypes of breast cancer. Conclusion PD-1 and PD-L1 is expressed in all subgroups of breast carcinoma. Patients in all such groups are amenable to immunotherapy, provided they are found suitable otherwise.

BACKGROUND: Ki-67 immunohistochemistry (IHC) staining is a widely used cancer proliferation assay; however, its limitations could be improved with automated scoring. The OncotypeDXTM Recurrence Score (ORS), which primarily evaluates cancer proliferation genes, is a prognostic indicator for breast cancer chemotherapy response; however, it is more expensive and slower than Ki-67. OBJECTIVE: To compare manual Ki-67 (mKi-67) with automated Ki-67 (aKi-67) algorithm results based on manually selected Ki-67 “hot spots” in breast cancer, and correlate both with ORS. METHODS: 105 invasive breast carcinoma cases from 100 patients at our institution (2011–2013) with available ORS were evaluated. Concordance was assessed via Cohen’s Kappa (κ). RESULTS: 57/105 cases showed agreement between mKi-67 and aKi-67 (κ 0.31, 95% CI 0.18–0.45), with 41 cases overestimated by aKi-67. Concordance was higher when estimated on the same image (κ 0.53, 95% CI 0.37–0.69). Concordance between mKi-67 score and ORS was fair (κ 0.27, 95% CI 0.11–0.42), and concordance between aKi-67 and ORS was poor (κ 0.10, 95% CI −0.03–0.23). CONCLUSIONS: These results highlight the limits of Ki-67 algorithms that use manual “hot spot” selection. Due to suboptimal concordance, Ki-67 is likely most useful as a complement to, rather than a surrogate for ORS, regardless of scoring method.

PURPOSE OF REVIEW: The purpose is to present a case series of rare diagnoses and unusual presentations of breast lesions with radiologic-pathologic correlation from a major cancer center, and to review the recent literature on each entity with a focus on radiology-pathology concordance. We present our findings and experience from cases of metastatic small cell lung carcinoma to the breast, IgG-4 related breast disease, breast implant associated anaplastic large cell lymphoma, granular cell tumor, pleomorphic sarcoma, adenomyoepithelioma, post-radiation angiosarcoma, and breast carcinoma after risk-reducing total mastectomy. RECENT FINDINGS: It is essential for physicians to have knowledge of rare breast diagnoses and unusual breast disease presentations to formulate a complete differential diagnosis, recognize radiological-pathological concordance of these entities and provide appropriate patient care. SUMMARY: Current literature on these rare described entities exists mainly as case reports, case series and small-scale studies. By sharing our findings, we hope to educate trainees in radiology, pathology and other fields across the continuum of care in radiologic-pathologic correlation, while also augmenting the existing literature on these rare entities.

Breast cancer is the most common carcinoma plaguing women in the United States. Invasive lobular carcinoma is the second most prevalent type of breast carcinoma with an incidence rate of 5% and 15% with high propensity for multifocal manifestation of disease. Multifocal disease is defined by two or more malignant foci within a single quadrant. Invasive lobular carcinoma is strongly associated with early menarche, late menopause, late age at first birth, and is typically seen in women ages 50 and older. Invasive lobular carcinoma can be difficult to detect clinically because lesions typically fail to form palpable masses, and it can be challenging to diagnose mammographically due to subtle imaging features of the lesions. Here we present a rare case of a palpable, unilateral, multifocal and multicentric lobular breast carcinoma in a young, previously healthy 41-year-old woman with no family history of breast cancer.

Objective MicroRNAs (MiRNAs) regulate mammalian cell growth, differentiation, and apoptosis by altering the expression of other genes and serve multiple roles in tumorigenesis and progression. Proto-oncogene serine/threonine-protein kinase (RAF-1) functions as a part of the MAPK/ERK signal transduction pathway. The present study aim was to prospectively evaluate MicroRNA 106a (MiR-106a) and RAF-1 as a diagnostic and prognostic factor in early prediction of breast cancer (BC), recurrence and early detection of distant metastasis as well as to analyses the statistical correlation between MiR-106a and RAF-1 levels and clinical-pathological parameters including tumor size, lymph node, histological type and grading. Methods Sera and plasma of 30 normal women and 50 women with breast carcinoma were assayed for MiR-106a by RT-qPCR as well as levels of Hb, WBCs and platelets count and RAF-1 by solid phase enzyme-linked immunosorbent assay (ELISA). Results The patients' characteristics, they were classified according to grade into 8% grade I, 66% grade II, 22% grade III and 4% grade IV. The stages were classified according to the TNM system as stage II was the highest percentage 66%, while the lowest percentage was 10% for stage I and 24% for stage III. Also, Hb% and RAF-1 levels were significantly decreased in breast cancer patients as compared with healthy control. On the other hand, MiRNA-106a gene expression was non-significantly increased in positive lymph node metastasis patients (FC=3.66) when compared to patients with negative lymph node metastasis (FC=3.51). In addition, MiR-106a was significantly up-regulated in breast cancer patients with a fold of change 3.63 when compared to control samples. Conclusion Expression of MiR-106a gene can be used as a diagnostic and prognostic noninvasive biomarker which can stimulates breast cancer cell invasion and proliferation through downregulation of Raf-1 levels. .

Background To analyse if performing unenhanced CT of the liver aids in the evaluation of metastatic lesions, response assessment or alter the size of the lesions, compared with portal phase alone, in patients with hepatic metastases from breast carcinoma. Patients and methods One-hundred and fifty-three CT scans of 36 women were included. Scans consisted of unenhanced, arterial and portal delayed phases of the liver. Two readers sorted which phase was best for visualization of metastases, evaluated the number of lesions detected in each phase, selected the best phase for assessment of response in two consecutive scans, and measured one target lesion in all the phases. Χ2 was used to compare differences among phases and paired t test for measurement differences. Results Unenhanced, arterial and portal phases were considered better phases by readers 1/2 in 68/67%, 27/28% and 69/70%, and some lesions were missed in 2%, 11% and 7%, respectively. Sensitivity was significantly better for unenhanced and portal phases compared to arterial phase. Comparison between consecutive scans was considered better in unenhanced (80/79%), followed by portal (70/69%) and arterial phases (31/31%). Maximum diameter of target lesions was 15% greater in unenhanced phase (p < 0.001). Conclusions Portal and unenhanced phases of the liver allow better detection and delineation of metastatic hepatic lesions from breast carcinoma. In most cases, unenhanced CT is the best phase to assess response and provides the largest diameter. Therefore, we recommend the use of unenhanced CT in the evaluation of patients with breast carcinoma and suspected or known hepatic metastatic disease.

Introduction. BRCA1 dysfunction is a hallmark of both hereditary and sporadic breast cancer. BRCA1 protein expression can be lost by germline mutation, somatic mutation or promoter hypermethylation. This study aimed to explore BRCA1 dysfunction in breast cancer patients by immunohistochemistry and to study its association with prognostic factors. Material and methods. BRCA1 protein expression was assessed by immunohistochemistry on formalin fixed paraffin embedded tissue blocks of 110 invasive breast carcinoma patients. Furthermore, the clinical findings and tumor features associated with BRCA1 dysfunction were characterized. Results. Reduced BRCA1 immunoreactivity was observed in 19% of breast cancer cases. Although these patients presented with aggressive tumor characteristics, statistical significance was observed only with presence of lymphovascular emboli (p < 0.05). These results suggest that loss of BRCA1 protein expression is associated with an aggressive phenotype of breast carcinoma. Conclusions. Immunohistochemistry for BRCA1 protein expression in tumor tissues may provide a less expensive screening tool to identify BRCA1 dysfunction due to genetic or epigenetic alterations.

Introduction: The most common malignancy worldwide among females is breast carcinoma and the second most common malignancy in India, next to cervical cancer. A wide range of potential prognostic features have been studied in breast cancer and are mainly divided into two groups i.e. Histopathological and Molecular. The histological features are cost-effective and provide reliable diagnostic and prognostic information in these tumors. Axillary Lymph node status is one of the most important prognostic factors and greatly affects the morbidity and mortality of the patient. Materials and Methods: All breast cancer specimens received in the Department of Pathology over a period of five years. The following histopathological parameters were carefully studied like Tumor size, Histological type, Grade, Presence of necrosis, Inflammatory cell infiltrate, Lymphatic invasion, Blood vessel invasion, Perineural invasion, and other Stromal changes were studied in detail, and association of these histopathological parameters with axillary lymph node metastasis were analyzed. Results: A total of 100 cases were studied, and most of the patients were over the age of 50. The maximum number of cases was in the T2 stage (55%). Infiltrating ductal carcinoma (88%) was the most common type of tumor encountered in the study. The majority of the cases were Grade I tumors. Skin Invasion was seen in 14% and Lymphovascular Invasion was seen in 17% of cases respectively. There was a statistically significant association between the size of the tumor, T stage, Grade of the tumor, necrosis, and inflammatory infiltrate on further analysis. Conclusion: There was a statistically significant correlation between Tumor size, pathological T stage, Grade of the tumor, Necrosis and inflammatory infiltrate with axillary Lymph node metastasis in the present study. Increased tumor size, T stage, higher grade, presence of necrosis and low inflammatory infiltrate are associated with increased axillary Lymph node metastasis.

Invasion of carcinoma cells into surrounding tissue affects breast cancer staging, influences choice of treatment, and impacts on patient outcome. KIF21A is a member of the kinesin superfamily that has been well-studied in congenital extraocular muscle fibrosis. However, its biological relevance in breast cancer is unknown. This study investigated the functional roles of KIF21A in this malignancy and examined its expression pattern in breast cancer tissue. The function of KIF21A in breast carcinoma was studied in vitro by silencing its expression in breast cancer cells and examining the changes in cellular activities. Immunohistochemical staining of breast cancer tissue microarrays was performed to determine the expression patterns of KIF21A. Knocking down the expression of KIF21A using siRNA in MDA-MB-231 and MCF7 human breast cancer cells resulted in significant decreases in tumor cell migration and invasiveness. This was associated with reduced Patched 1 expression and F-actin microfilaments. Additionally, the number of focal adhesion kinase- and paxillin-associated focal adhesions was increased. Immunohistochemical staining of breast cancer tissue microarrays showed that KIF21A was expressed in both the cytoplasmic and nuclear compartments of carcinoma cells. Predominance of cytoplasmic KIF21A was significantly associated with larger tumors and high grade cancer, and prognostic of cause-specific overall patient survival and breast cancer recurrence. The data demonstrates that KIF21A is an important regulator of breast cancer aggressiveness and may be useful in refining prognostication of this malignant disease.

Concomitant expression of two neoplasms- cervical carcinoma (CC) and breast carcinoma (BC) is a relatively rare pathology. The manifestation of synchronous primary neoplasms is a challenge for the treating team as it puts a number of questions about the healing strategy. We present a 57-year-old patient after total laparohisterectomy with lymphatic pelvic dissection on the local advanced CC/IIIB clinical stage. Intensity-modulated radiotherapy (IMRT) in the small pelvis and the upper 2/3 of the vaginal cuff with daily dose (DD) 1.8 Gy up to total dose (TD) 50.4 Gy combined with Cisplatin (50 mg/m2) once a week, was conducted. After 4 months from the diagnosis and complex treatment of CC, PET/CT establishes a second neoplasm-invasive ductal carcinoma in the left mammary gland. After the breast-conserving surgery of BC, we are currently conducting Deep Inspiration Breath-Hold (DIBH) Radiation Technique on the left breast with DD 2 Gy up to TD 50 Gy. After 1 month of pelvic RT completion, RT on the paraaortal lymph nodes with DD 1.8 Gy up to TD 50 Gy should be conducted. The discussion focuses on the simultaneous expression of two or more neoplasms, their relationship with genetic and other unfavorable predisposing factors, as well as the expected survival after the complex treatment of the two invasive carcinomas, involving IMRT. For the treatment of multiple malignancies, each case must be considered individually, ideally by a multidisciplinary team. If it is necessary to apply radiotherapy, the use of high-tech radiotherapeutic apparatus with the ability to perform modern radiotherapy techniques such as IMRT is required.

Diabetes mellitus is a comorbid condition that is commonly seen in Indian population. Breast cancer is the second most common cancer among women. This can occur due to modifiable and non-modifiable risk factors. This study aims to analyses about the impact of diabetes mellitus on breast cancer outcomes. This study is a hospital record based descriptive cross – sectional study. Ethical clearance for the study was obtained from the institutional review board. All the patients diagnosed and on treatment for carcinoma breast in the year 2020 in the hospital was taken into consideration. Details about their age, stage at the time of diagnosis, presence of diabetes, their outcome at the end of study period was collected. The data were analyzed with the help of a statistician. Diabetic patients had a slight chance of later stage of presentation as well as outcome in comparison with the non-diabetic counterparts. So, Care should be taken in diagnosing by screening and treating the diabetic patients with breast cancer.

Pigmented epidermotropic breast cancer metastases are a rarity, often clinically misdiagnosed as melanocytic lesions. Histopathologically, they show a dermal proliferation of neoplastic metastatic cells that extend to the overlying epidermis in a pattern identical to that seen in primary Paget disease (PD). Differential diagnosis should be established with entities with a similar presentation, such as pigmented mammary PD and malignant melanoma. Immunohistochemistry may be useful for this purpose. We present a new case of pigmented epidermotropic breast cancer metastases with a particularly unusual feature: the absence of dermal infiltration by neoplastic cells, thus considered as pure epidermotropic metastatic involvement.

Breast augmentation with implants is a popular cosmetic procedure which has been performed for nearly six decades. As the number of breast augmentation procedures continually rises, we increasingly encounter breast cancer patients who have silicone implants. A significant portion of these patients includes candidates suited for lumpectomy. In these cases, a major concern is the potential exposure of the implant during lumpectomy while an additional consideration is the need to replace the implants due to their age or condition. The purpose of this study is to present an original surgical approach to patients with breast implants requiring breast conservative resection due to breast carcinoma. Over the course of 10 years, breast-augmented candidates for a lumpectomy who underwent a technique that combines lumpectomy with the replacement of the old implant through an incision from the previous scar in the inframammary fold (IMF) were reviewed. With this approach, after removal of the implant through the IMF incision, the tumor is resected with appropriate surgical margins from inside the implant pocket, leaving the overlying skin intact. Data on demographic characteristics, implants, oncologic information, intraoperative surgical findings, and complication were collected. The implant information included brand, size, age, plan of dissection, and condition of the implant as assessed preoperatively. Oncologic information included tumor type, number of tumors, size, and location. Surgical information included the size of the tissue excised, condition of the implant removed, as well as characteristics of the new implants, plane of augmentation, and intraoperative and postoperative complications. All breast specimens were marked and weighed, and the patients were followed-up postoperatively for at least 6 months by the plastic and breast surgeons and by the oncologists. This technique has been employed in 21 patients with previous breast augmentation and a recent diagnosis of breast carcinoma. The average implant age was 13.3 years. The average tumor size was 2.1 cm × 2.8 cm. All patients had clear surgical margins. No significant complications were reported. This technique enables the performing of a lumpectomy procedure without adding additional scars to the breast, the exchange of the implant in a simultaneous procedure, and the decrease of the risk of implant exposure due to additional scars on the breast parenchyma. It minimizes postoperative complications and provides excellent results both therapeutically and aesthetically.

Background: Tumor growth and development is determined by the mutual interaction between the cancer cells themselves and the microenvironment. It contains various elements, including immune cells. Of all, mast cells have one of the most controversial roles. The aim of the present study was to evaluate the expression of mast cell tryptase in the luminal and non-luminal subtypes of breast cancer and establish a possible link between infiltration with MCs and expression of hormone receptors. Material and methods: The experimental study included 80 cases of breast carcinomas that were analyzed immunohistochemically in order to establish the molecular profile and the expression of tryptase, a specific marker of mast cells. The data were processed using the SPSS program. Pearson’s coefficient (r) and the other values were considered statistically significant in case of p≤0.05. Results: Both intratumoral mast cells (MCit) and peritumoral mast cells (MCpt) correlated with the expression of hormone receptors for estrogen (ER) and progesterone (PR). Thus, the following relations were established: MCit and ER (r=0.343, p=0.002), MCpt and ER (r=0.394, p=0.000295) and MCpt and PR (r=0.386, p=0.000409). Statistically significant correlations between HER2 expression and mast cells content have not been established. Conclusions: Mast cells invasion, peri- and intratumoral, is strongly influenced by the expression of hormone receptors. The luminal subtypes of breast cancer are characterized by a higher density of mast cells.

Background: Prognosis of breast cancer and success of therapeutic interventions largely rely on clinico-pathologic and biological characteristics of tumor and vary due to the heterogenous nature of breast cancers. This study was intended to find correlation between the expression of Estrogen receptor (ER), Progesterone receptor (PR) and Human Epidermal Growth Factor Receptor-2 (HER-2/neu) with histological grade in case of carcinoma of breast. Material and Method: This study was conducted on 56 histologically confirmed specimens of breast carcinoma in Department of Pathology, Surat Municipal Institute of Medical Education and Research. Results: Maximum number of cases of breast carcinoma were found in 41-50 years aged females. Invasive ductal carcinoma-not otherwise specified (IDC-NOS) (82.14%) was most common histological type. Most of the carcinoma showed grade II (62.5%). ER, PR and HER-2/neu positivity was 50%, 42.86% and 42.86% respectively. Conclusion: Evaluation of ER, PR and HER-2/neu status and tumor grade should be incorporated routinely as a part of histopathological reports in all cases of breast carcinoma as they not only help in histopathologic assessment of prognosis, but also help in deciding the management thereby improving overall survival.

Background We explored the hypothesis that high-quality standards in diagnostic mammography can lead to an early diagnosis of breast cancers and identifies at risk populations outside screening programs. The histopathological features and distribution of the TNM classification were examined in relation to patient age in a large group of women with breast cancers participating in the Quality Assured Mamma Diagnostic (QuaMaDi) program of the state of Schleswig–Holstein. Patients and methods Surgical pathological reports were studied for clinicopathological characteristics, receptor status, molecular subtype and tumor stage. The analysis was conducted by dividing the study population into three age groups: women under 50 years (pre-screening), 50–69 years (peri-screening) and over 70 years (post-screening). Results 7.111 biopsies and 2.887 resection specimens were included. Breast cancer was diagnosed in 4.241 (59.7%) cases, one fourth of them in women 70 years) had more well-differentiated, estrogen receptor (ER)-positive and HER2-negative carcinomas, whereas younger women ( Conclusion In QuaMaDi breast cancer was diagnosed at an early and potentially curable stage of the disease due to high-quality standards in diagnostic mammography. In addition, regardless of age, an increased number of prognostically unfavorable molecular subtypes were detected. Thus, QuaMaDi helps to identify at risk populations. QuaMaDi significantly improves diagnostic mammography and complements mammography screening programs.

A female patient diagnosed of infiltrative breast carcinoma using tru-cut biopsy underwent 18flourine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for staging. The tumor was located in the superior external quadrant of the right breast, and did not exhibit pathological uptake in 18F-FDG PET/CT. Later, gallium-68 (68Ga) fibroblast activation protein-specific inhibitor (FAPI)-04 PET/CT imaging was performed and the primary tumor showed intense radiotracer accumulation. This presumes that 68Ga-FAPI PET/CT imaging is superior to 18F-FDG imaging in detecting the primary tumor in breast cancer, thereby suggesting the replacement of FAPI by 18F-FDG in breast-cancer staging in the future.

Introduction: Breast cancer is one of the most common cancers among women in the world. The high incidence of breast carcinoma in women has inspired a thorough investigation of potentially modifiable risk variables (clinical parameters, morphological type, and biochemical indicators) for prognosis, preventative tactics, and treatment options. One of the most important prognostic indicators for breast cancer is p53. Aims and Objectives: The goal of this study was to use immunohistochemistry to assess the prevalence of p53 mutant protein in breast cancer, correlate the results with clinical and histological parameters, and establish its impact on axillary node metastasis. Materials and Methods: A clinicopathological study of 50 cases of infiltrating ductal carcinoma of the breast was performed using immunohistochemistry to examine for p53 mutant protein expression. Results: Percentage of p53 immunohistochemical positivity in this study was 22%, which is similar to other studies' reported statistics. In both the positive and negative cases of lymph node metastases, immunohistochemical data revealed an equivocal p53 status. In compared to p53 negative cases, the carcinomas with p53 positivity showed aggressive characteristics, such as greater size and higher grade. Patients with significant lymphocytic reactions to tumours, patients under 35 years of age, and those with tumours on the left side had a higher chance of receiving a positive p53 status. This study clearly shows that breast cancers with high p53 expression are generally aggressive tumours with a poor prognosis and a poor response to endocrine treatment and chemotherapy.

BACKGROUND: Multiple primary malignancies are two or more malignancies in an individual without any relationship between the tumors. The development of improved diagnostic techniques, increased survival of cancer patients and the growing life expectancy have all contributed to the increased frequency of this phenomenon. OBJECTIVE: The aim of this study is to review the multidetector computed tomography (MDCT) findings of synchronous breast carcinoma and other solid malignancies. METHODS: This retrospective study included 65 patients confirmed with diagnosis of synchronous breast carcinoma and other solid malignancies. CT scanning was performed using 128 MDCT in all patients. All one hundred-thirty malignancies underwent pathological evaluation. RESULTS: Out of 4120 patients with breast carcinoma; 65 patients were diagnosed with other synchronous primary solid malignancy. All one hundred-thirty malignancies were confirmed pathologically. Breast carcinoma detected in all 65 patients; of them metastatic breast carcinoma detected in 8 patients. Hepatocellular carcinoma was detected in 18 patients, Non-Hodgkin lymphoma (NHL) in 12 patients, endometrial carcinoma in 8 patients, uterine sarcoma in 3 patients, malignant mixed Müllerian tumor in one patient, ovarian carcinoma in 5 patients, renal cell carcinoma in 4 patients, thyroid carcinoma in 4 patients, gastric carcinoma in 2 patients, colonic carcinoma in 2 patients, ano-rectal carcinoma in one patient, hilar cholangiocarcinoma in 2 patients, malignant melanoma in 2 patients and bronchogenic carcinoma in one patient. CONCLUSIONS: Patients with breast carcinoma have a risk of other synchronous primary malignancy. So, careful preoperative examination is recommended to improve the patients’ prognosis. MDCT scanning is accurately imaging modality for evaluation of synchronous breast carcinoma and other solid malignancies. The aim of treatment in cancer patients should always be curative even in the presence of multiple malignancies.

BACKGROUNDS: Breast cancer or breast carcinoma is the most common type of malignancy in women globally. According to the previous studies that indicate the usage of antihypertensive drugs may become a risk factor of cancer (beta-blockers [BBs], calcium channel blockers [CCBs], and diuretics). Both angiotensin-converting enzymes inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), on the other hand, have been associated to an increased or decreased risk of breast cancer. AIM: To compare each type of antihypertensive medicines as a risk factor for breast cancer, we did a systematic review and meta-analysis of current evidence. METHODS: We utilized the terms “antihypertensive”, “anti-hypertensive”, “anti-hypertensive medications”, “breast cancer”, “risk”, “case control”, and “cohort” in PubMed, ScienceDirect, and Google Scholar databases. RESULTS: Our data calculation found that the risk of antihypertensive drugs was significantly different in overall analysis (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.42–0.83, p = 0.003). Five studies with 39.503 breast cancer patients and 372.037 controls were included in the ARBs user sub-group. Our results found significant different of antihypertensive drugs among breast cancer patient (OR = 1.47, 95% CI = 1.02–2.11 p = 0.04). Our data calculation also confirmed no significant different in antihypertensive drugs among breast cancer patient (OR = 1.07, 95% CI = 0.99–1.16, p = 0.09) in diuretics user, (OR = 1.08, 95% CI = 0.99–1.18, p = 0.08) in CCBs user, (OR = 1.11, 95% CI = 0.98–1.26, p = 0.09) in BBs user, and (OR = 1.27, 95% CI = 0.64–2.50, p = 0.50) in ACEIs user. CONCLUSIONS: Although, the finding reveal that antihypertensive drugs (diuretics, CCBs, BBs, and ACEIs) in overall are significant for the risk of breast cancer and also found that ARBs have a low potential in the risk of breast cancer.

Context.— The American Society of Clinical Oncology/College of American Pathologists updated the human epidermal growth factor receptor 2 (HER2) breast carcinoma testing guideline in 2018 to address issues from uncommon HER2 fluorescence in situ hybridization (FISH) results. Based on the 2013 American Society of Clinical Oncology/College of American Pathologists guideline, cases wherein the HER2/chromosome 17 centromere (CEP17) ratio of 2.0 or more with an average HER2 copy number of less than 4.0 were considered in situ hybridization (ISH) positive. Under the 2018 guideline, such cases are classified as ISH Group 2 and are no longer considered eligible for anti-HER2 therapy when the corresponding HER2 immunohistochemistry result is 0, 1+, or 2+. Objective.— To assess the clinical, pathologic, and treatment aspects of patients with ISH Group 2 results. Design.— We retrospectively reviewed HER2 FISH results at our center between January 2012 and December 2014 and identified and characterized cases with ISH Group 2 results. Results.— Thirty-nine cases with ISH Group 2 results from 39 patients were reviewed. Twenty of 39 (51%) patients received anti-HER2 therapy. Patients treated with HER2-targeted therapy were less likely to have hormone receptor–positive tumors, compared with patients without anti-HER2 treatment, though not significantly (P = .30). The only significant difference between the 2 patient groups was receipt of cytotoxic chemotherapy treatment (P < .001). Overall, clinical outcome was similar between the 2 groups (P > .99). Conclusions.— This retrospective study with median follow-up of at least 6 years shows patients with ISH Group 2 tumors had similar clinical outcomes, irrespective of HER2-targeted therapy. Further analysis in the prospective setting would provide valuable data that would potentially inform clinical decision making.

BACKGROUND: FAS can serve as both an oncogene and a suppresser in different malignancies, and the prognostic value of FAS remains controversial. METHODS: The Oncomine database, KM-Plotter and bc-GenExMiner platform were adopted to analyze the prognostic value of FAS in breast cancer. Breast cancer tissue microarrays were further used to verify these data. The Cell Miner Tool was used to predict the value of FAS mRNA expression in predicting the efficacies of clinical drugs. RESULTS: We found that both FAS mRNA and protein expression level significantly reduced in breast carcinoma. In addition, high FAS expression indicates a better metastatic relapse-free survival. Interestingly, FAS was associated with a better prognosis in different subtypes of breast cancer patients, namely, only in grade II and III, lymph nodal positive or p53 wild-type patients. The data from the Cell Miner Tool revealed that FAS mRNA expression was correlated with the efficacy of the first-line chemotherapeutic taxane agents and target drugs including olaparib and everolimus. CONCLUSIONS: FAS expression correlates with a better prognosis in breast cancer and may provide an effective clinical strategy to predict the sensitivity of taxanes and targeted drugs.

Resumen Introducción. El cáncer de mama es la neoplasia maligna más frecuente en las mujeres de todo el mundo. Los distintos subtipos intrínsecos tienen pronósticos diferentes y su prevalencia varía significativamente según los criterios establecidos en el Consenso de Saint Gallen. Objetivo. Clasificar los subtipos luminales del carcinoma de mama en una población de pacientes venezolanas según los consensos de Saint Gallen del 2009, 2011, 2013 y 2015. Materiales y métodos. Se hizo un estudio retrospectivo en 209 pacientes con carcinoma ductal infiltrante de mama, atendidas en el Instituto de Oncología "Dr. Miguel Pérez Carreño" de Valencia, Venezuela. Resultados. La distribución de los subtipos luminal A y B cambió después de reclasificar los casos según los consensos de 2011, 2013 y 2015; el subtipo luminal B fue el más común en la serie de estudio. Conclusiones. Mediante la clasificación basada en los últimos criterios de Saint Gallen, se determinó un número mayor de tumores luminales B, lo que ayudaría a seleccionar a aquellas pacientes que no requieran la quimioterapia adyuvante y a quienes puedan beneficiarse de la terapia hormonal adyuvante en la práctica clínica. Abstract Introduction: Breast cancer is the most frequent malignancy in women worldwide. Different intrinsic subtypes have different prognoses and their prevalence varies significantly according to the criteria established in the Saint Gallen Consensus. Objective: To classify the luminal subtypes of breast carcinoma according to Saint Gallen 2009, 2011, 2013, and 2015 consensuses in a group of Venezuelan patients. Materials and methods: We conducted a retrospective study in 209 patients with infiltrating ductal carcinoma of the breast followed up at the Institute of Oncology "Dr. Miguel Pérez Carreno" in Valencia, Venezuela. Results: The distribution of the luminal A and B subtypes changed after the reclassification of the cases according to 2011, 2013, and 2015 Saint Gallen Consensuses. The luminal B subtype was the most common in the study series. Conclusions: With the use of a classification based on the latest Saint Gallen criteria we identified more luminal B tumors. This could contribute to selecting those patients who can avoid adjuvant chemotherapy and/or benefit from the adjuvant hormonal therapy in clinical practice.

BACKGROUND Due to the increasing number of diagnosed nonpalpable breast cancer cases, wire localization has been commonly performed for surgical guidance to remove nonpalpable breast lesions. This report presents a rare case of localized wire migration to a subcutaneous lesion of the upper back in a breast cancer patient undergoing breast-conserving surgery. CASE SUMMARY A 48-year-old female was scheduled for breast-conserving surgery for left breast cancer. Ultrasonography guided wire localization was performed intraoperatively by surgeon to localize the nonpalpable breast cancer. After axilla sentinel lymph node biopsy, we realized that the wire was not visualized. The wire was not found in the operation field, including the breast and axilla. Breast-conserving surgery was performed after wire re-localization. Intraoperative chest posteroanterior view revealed that the wire was located on the level of midaxillary line. Two days after the operation, a serial simple X-ray revealed that the wire was located on the subcutaneous lesion of the back. The wire tip was palpable under the skin of the upper back, and the wire was removed under local anesthesia. CONCLUSION Hooked wire misplacement can lead to fatal complications. Surgeons must consider the possibility of wire migration during breast cancer surgery.

AIM: Cancer breast is one of the most common cancer in women leading to death; that is why we are in urgent need to develop new modalities of treatment. Mesenchymal stem cells (MSCs) have an anti-inflammatory effect due to capability to regenerate the damaged tissues. METHODS: MCF7 breast cancer cells were divided into two groups; group 1: untreated cancer cells, group 2: cancer cell cocultured with MSCs; after 24 incubation the cells from the two groups were collected to assess cell proliferation, Interleukin-6 (IL-6) levels and genes expression of Nuclear factor-kappa B (NF-KB), FOXO, and LncRNA AF085935. RESULTS: Statistically significant decrease in cancer cell proliferation and all other studied parameters in cancer cells after coculture with MSCs. CONCLUSION: Breast carcinoma once initiated; it runs in a vicious circle due to stimulation of FOXO/LncRNA AF085935 axis by the inflammatory mediators released from cancer environment. FOXO/LncRNA AF085935 induces cancer proliferation and survival; furthermore, FOXO once induced, it produces further induction of inflammatory cytokines IL-6 and NF-KB and so on, MSCs due to its anti-inflammatory role could break this circle and thus inhibit cancer cell proliferation.

Pakistani females are at elevated risk of breast cancer, hence there is a need to explore every possible potential contributing factor. The present study was performed to analyze the perception of women about their Vit-D levels in both urban and rural areas. Women included 154 clinically diagnosed breast cancer patients from different hospitals and 248 randomly selected females as control group were recruited from Punjab, Pakistan. Statistical analysis was done using SPSS to find the association of Vit-D deficiency with breast carcinoma in different age groups. Out of a total of 402 respondent, 51.5% were completely ignorant of their Vit-D level. Pearson's Chi- square test for those who had perception about Vit-D deficiency among the breast cancer patients and control group revealed asymptotic 2-sided significance of 0.004 while among different age groups, 41 to 50 years were most prone to deficiency with

Immediate breast reconstruction has become an important supplement after modified radical mastectomy. The role of preoperative breast reconstruction information has not been widely popularized in China. It may play an important role in choosing immediate breast reconstruction. In this paper, we investigated whether there was an effect of the role of preoperative breast reconstruction information on the difference about choosing immediate breast reconstruction after modified radical mastectomy at signing the operation consent. From 2015 January to March 2018, newly admitted 100 patients with breast carcinoma must receive modified radical mastectomy. All these patients’ conditions met the requirements of immediate breast reconstruction. Patient age, breast reconstruction cognition, marital status, education, and family economics were recorded. They were randomly classified into two groups (A & B). Preoperative breast reconstruction information was designed and prepared. When it came to signing operation consent, Group A received preoperative breast reconstruction information and Group B did not receive it. We recorded whether they were willing to receive immediate breast reconstruction in different groups. There was no significant difference in patient age, breast reconstruction cognition, marital status, education, and family economics (P > 0.05). Thirty-two patients agreed to receive breast reconstruction and 18 patients did not agree to receive breast reconstruction in Group A when 24 patients agreed to receive breast reconstruction and 26 patients did not agree to receive breast reconstruction in Group B. There was a statistical significance (P

Breast cancer is one of the three most common cancers occurring worldwide. In 2018, one in four newly detected cancer in women was breast cancer in India. Breast cancer treatment approaches have changed from “maximum tolerable” to “minimum effective” with the same cure rates and cosmesis but better quality of life (QoL). However, the management of the axilla has been a debatable topic since many decades. For the proper management of breast cancer, it is essential to differentiate clinically node-positive or clinically node-negative patients but having a positive sentinel lymph node (SLN). Axillary staging is one of the most important prognostic variables in breast cancer treatment. Sentinel lymph node biopsy (SLNB) may spare many patients the need for axillary lymph node dissection (ALND) as well as the morbidities associated with ALND. In this review, we have discussed the observations from various trials and guidelines recommendations on the need or omission of ALND in patients with breast cancer undergoing SLNB. The various tracer used for identification of SLN and the best combination available for staging the axilla with high accuracy and low risk of false negativity has been assessed. The timing and accuracy of SLNB in patients who are receiving neoadjuvant chemotherapy (NACT) for breast cancer have also been discussed. The impact of ALND on locoregional recurrence (LR), overall survival (OS), and disease-free survival (DFS) outcomes in SLNs positive patients has been evaluated. We have proposed a treatment algorithm to follow, in addition to the local/regional guideline recommendations, before planning the treatment strategy for breast cancer patients.

Introduction: Breast cancer is the second most common cancer in the world. One of the reasons for its increasing prevalence, especially in younger women has been attributed to lifestyle changes. All these factors also have a strong association with lipid metabolism. More evidence is coming forward to emphasise the protective effect of lifestyle modification to lower lipid levels and thus decreasing the risk of breast cancer. Methods: It is a retrospective, case control study. The patients with carcinoma breast and normal controls were taken as subjects. The data for this study includes clinical profile and lipid profile measured in early morning fasting sample of the subjects. The patients of carcinoma breast, normal control aged > 18 years were included, while patients with diabetes, thyroid disorders, on treatment for hyper-lipidaemia, dieting or anorexic, pregnant patients were excluded. Results: There was no statistically significant differences in age (p = 0.920) and BMI (p = 0.137) between study and normal control group. Total Cholesterol (TC) and Triglycerides (TG) levels were significantly elevated (p = 0.009 and 0.000 respectively) in carcinoma breast group compared to normal controls, however no significant differences (p > 0.05) observed in the levels of HDL-C, LDL-C. Conclusions: There is a significant alteration in lipid metabolism in carcinoma breast patients in comparison to normal controls.

Neoadjuvant systemic therapy is the standard of care in the treatment of locally advanced breast cancer. Heterogeneity of tumour microenvironment complicates the response to the treatment. Very few studies focus on the response pattern of neoadjuvant chemotherapy in locally advanced breast carcinoma. We aim to hypothesize that breast cancer microenvironment has a heterogeneous pattern. This is prominent when skin is involved and can be attributed to a higher distribution of cancer stem cells on the surface compared to the core and is independent of tumour biology.