We report her on a case of adenoid cystic carcinoma (ACC) associated with adenomyoepithelioma of the breast in a 73-year-old woman. ACC accounts for about 0.1% of all breast cancers. The patient presented with a large, nodular, rubbery mass that measured 5.5x4.0 cm in the subareolar region of the left breast. Light microscopy revealed various growth patterns of ACC with the adenomyoepitheli oma. Immunohistochemically, the epithelial cells in the ACC component reacted strongly for cytokeratin. The myoepithelial cells stained for smooth muscle actin, vimentin and S-100 protein, whereas staining for cytokeratin was weak. The adeno myoepithelioma component showed a similar staining pattern. Reactivity for both estrogen receptor (ER) and progesterone receptor (PR) were negative. There seems to be a spectrum of adeno myoepithelioma-related epithelial and myoepithelial lesions that ranges from low grade to high grade. Therefore, we suggest the present case of ACC arose from an adenomyoepithelioma or there is a close relationship among these combined epithelial and myoepithelial tumors. For both mammary ACC and adenomyoepitheliomas, complete excision with a margin of uninvolved tissue is the recommended treatment. Most of these patients will have an excellent prognosis.
Actins ; Adenoids* ; Adenomyoepithelioma* ; Aged ; Breast Neoplasms ; Breast* ; Carcinoma, Adenoid Cystic* ; Epithelial Cells ; Estrogens ; Female ; Humans ; Keratins ; Microscopy ; Muscle, Smooth ; Myoepithelioma ; Prognosis ; Receptors, Progesterone ; S100 Proteins ; Vimentin

PURPOSE: We wished to evaluate the prevalence and clinical features of axillary web syndrome (AWS) after sentinel node biopsy (SNB) and axillary lymph node dissection (ALND) during the conservative treatment of early breast cancer. METHODS: From March to November 2003, a total of 110 consecutive patients with clinical T1-T2 breast cancer underwent breast conserving surgery, with ALND being performed in 98 patients or SNB being performed in 12 patients. The diagnostic criterion for AWS was the presence of palpable and visible cords of tissue in the axilla upon maximal shoulder abduction. The extent of AWS was evaluated by inspection and by palpation of the axilla and the arm. RESULTS: Ten of 110 patients (9%) developed AWS. The AWS typically presented in the first several weeks after surgery and it resolved within 1 month of onset for all the patients. AWS was encountered for 3 patients (25%) among the patients who had SNB and for 7 patients (8%) among the ALND group, which is not statistically significant. Typically, the syndrome was self-limiting, and it resolved without any specific treatment. CONCLUSION: AWS is a significant cause of morbidity in the early postoperative period for 9% of the patients after axillary surgery. A more limited axillary surgery might help reduce the incidence and severity of the AWS.
Arm ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Node Excision* ; Lymph Nodes* ; Mastectomy, Segmental ; Palpation ; Postoperative Period ; Prevalence ; Shoulder

PURPOSE: Women with huge breasts suffer cervical, shoulder and back pain, breast pain and limitations of their daily activities, and all of this can create a functional disability and poor quality of life. Many patients with huge breasts need a reduction surgery not only for cosmetic purposes but also for functional improvement. METHODS: Fifty reduction mammoplasty cases that were operated in M.D. Clinic from April 2001 to August 2004 were retrospectively reviewed. Patient's age, the amount of removed breast tissue and the method of operation were evaluated, and 38 of these cases were surveyed by phone concerning the changes of their physical symptoms. RESULTS: The mean age of the cases were 37.3, and the ages ranged from 18 to 57. The amounts of removed tissue ranged from 50 g to 605 g (mean of right side: 275 g, and left side: 271 g). Nine cases of Benneli's circumareolar scar technique, 9 cases of inferior pedicle flap (inverted T scar) and 32 cases of circumvertical bipedicle flap were performed. Among the 38 cases that were surveyed by phone, most of them had suffered physical symptoms preoperatively, including cervical and shoulder pain (31 cases, 81.6%), back pain (35 cases, 92%), breast pain (21 cases, 55.3%), submammary rash (24 cases, 63.2%), fatigue (14 cases, 36.8%), headache (15 cases, 39.5%), numbness in hands (6 cases, 15.8%) and depression or nervousness (29 cases, 76.3%). The majority of survey respondents reported improvement in cervical and shoulder pain (100%), back pain (100%), fatigue (100%), headache (100%), breast pain (90.5%), submammary rash (91.7%), depression or nervousness (82.7%). Furthermore, there were additional gains including increased ability to enjoy physical exercise and social activity, improvement in the fit of their clothing and in their self-esteem. Adverse sequelae included scars (21 cases, 55.2%), asymmetry (11 cases, 28.9%), decrease in nipple sensation (13 cases, 34.2%), infection (1 cases, 2.6%) and hematoma (1 cases, 2.6%). CONCLUSION: Huge breast create physical symptoms including cervical and shoulder pain, back pain, breast pain, submammary rash, and other social and psychological problems. Reduction mammoplasty can improve the majority of these symptoms caused by huge breast, and this is an operation to help mend a functional disability.
Anxiety ; Back Pain ; Breast ; Cicatrix ; Clothing ; Surveys and Questionnaires ; Depression ; Exanthema ; Exercise ; Fatigue ; Female ; Hand ; Headache ; Hematoma ; Humans ; Hypesthesia ; Mammaplasty* ; Mastodynia ; Nipples ; Quality of Life* ; Retrospective Studies ; Sensation ; Shoulder ; Shoulder Pain

PURPOSE: Whole breast irradiation (WBI) after breast conserving surgery (BCS) is the standard treatment modality for controlling ipsilateral local recurrence of breast cancer. However, the WBI needs 5 to 6 weeks of the treatment period. Partial breast irradiation (PBI) has recently appeared as an alternative treatment to WBI in selected early breast cancer patients. This study was performed to evaluate the feasibility of PBI alone after BCS. METHODS: The brachy-catheters were inserted at the lumpectomy site after BCS. Six to nine days after the operation, the patients underwent fractionated PBI twice in a day with median dose of 3 Gy. The median value of the total dose was 3,120 cGy (28 to 34 Gy) given over 5 days. Forty-one patients who were proven as having a tumor-free margin by pathologic report were included in this study. Thirty-five patients had axillary lymph node-negative disease and thirty- six patients underwent concurrent adjuvant CMF chemotherapy. Follow-up ultrasono graphy was performed one month after the completion of PBI. RESULTS: The median post-operative hospital stay was 15 days (range: 12-17 days). Twenty-eight patients had seromas smaller than 1 cm in size and the 13 patients appeared to have 1~3 cm sized seromas on the follow-up ultrasonography. Long lasting (> 3 months) seromas were observed in 7 patients. None of the patients complained of tenderness or discomfort of the operation site and complications such as skin desquamation, pigmentation and wound contracture were not observed. Fat necrosis was observed in 1 patient. There was no case of local recurrence at the median follow-up period of 19 months (range: 15-41 months). CONCLUSION: PBI for early breast cancer using interstitial brachytherapy was a safe and effective alternative to WBI with excellent cosmetic results after BCS. The results of the current study prompts a multi-center clinical trial of PBI as an alternative to the WBI in early breast cancer to validate its feasibility in a selected patient population.
Brachytherapy ; Breast Neoplasms ; Breast* ; Contracture ; Drug Therapy ; Fat Necrosis ; Follow-Up Studies ; Humans ; Length of Stay ; Mastectomy, Segmental* ; Pigmentation ; Recurrence ; Seroma ; Skin ; Ultrasonography ; Wounds and Injuries

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis for early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10+LN). Breast cancer patients who had 10+LN clearly have a strikingly high risk of tumor recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients who had more than 10 positive axillary lymph nodes. METHODS: Of the 587 breast cancer patients who were operated on at Chungnam National University Hospital from February 1992 to November 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and the differences in survival according to the clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50+/-4 years. A mastectomy was done in 28 cases (90.3%), and a breast conserving operation was done in 3 cases (9.7%). The mean tumor size was 4.8+/-.5 cm. The mean number of removed axillary Lymph Nodes was 23.5+/-0.2 (range:10-52), and the mean number of positive axillary LNs was 20.0+/-10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 23 cases (69.6%) showed distant metastases as the first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up taking their adjuvant chemotherapy than for those patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in those patients who were treated using a combination chemotherapy with taxane plus cisplatin after their tumor recurrence. CONCLUSION: Breast cancer patients with 10+LNs have a strikingly high risk of tumor recurrence. Six cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of tumor recurrence. A combination chemotherapy with taxane and cisplatin was also a controllable variable for increasing survival after tumor recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence

PURPOSE: Post-authorization survey(PAS) is a useful tool for obtainting wider range of data on the safety and efficacy of new drugs following their approval, as they can detect uncommon, unreported adverse events(AEs), which enables more attention to be directed to the practioners. Especially, the limited number of patients in oncology trial cannot usually give the actual incidence of AEs. METHODS: Since Nov. 1998, when docetaxel gained Korean approval in the treatment of breast cancer, a PAS to investigate its safety profiles has been conducted targeting more than 600 patients over 4 calendar years. RESULTS: Case report forms from 626 out of 646 patients were assessable for safety and 444 for efficacy. The patient characteristics are: mean age, 48.1 years; male/female 4/622; Wt/Ht/BSA 57.9 kg/156.1 cm/1.56 m2 ; stage I-II/III/IV 109 (18.2%)/125 (20.8%)/366(61.0%). In 344 patients, 960 AEs were reported in severity of mild/moderate/severe in 6.7, 40.9 and 51.1 % of cases. From AE results, 36.0% needed dose reduction; 34.3% transient interruption of the cycle; and 1.3% permanent discontinuation of docetaxel. Thirty five serious AEs such as febrile neutropenia, alopecia, diarrhea, abdominal pain and headache were reported in 21 patients. Unexpected AEs such as skin ulcer, discoloration of skin, H. Zoster infection, ulticaria, facial flush, chest pain, hemoptysis, pneumonia, stridor, nasal bleeding, photophobia, haematuria, Cushing's syndrome, hyperglycemia and insomnia were reported regardless of any causal relationship. Factors affecting the development of AEs were age, stage, concomitant medication other than chemotherapeutic agents and the number of cycles treated. The efficacy was evaluable in 444 patients with overall response rate of 36.5% (CR/PR 6.3/30.2%). Factors affecting the efficacy were stage, concommitant medication other than chemotherapeutic agents and the number of treatment cycles. CONCLUSION: This post-authorization survey on the safety and efficacy of docetaxel in breast cancer offers oncology practice in the real world without subject selection as is the case in clinical trials, although it was performed to fulfill the registrative requirement of the Korean health authority with limited data. The efficacy and safety profile of docetaxel in breast cancer was no much different from those reported in clinical trials.
Abdominal Pain ; Alopecia ; Breast Neoplasms* ; Breast* ; Chest Pain ; Cushing Syndrome ; Diarrhea ; Epistaxis ; Febrile Neutropenia ; Headache ; Hemoptysis ; Herpes Zoster ; Humans ; Hyperglycemia ; Incidence ; Photophobia ; Pneumonia ; Respiratory Sounds ; Skin ; Skin Ulcer ; Sleep Initiation and Maintenance Disorders

PURPOSE: This study was conducted to evaluate the relationship of the biological parameters for survival after tumor recurrence or metastases for breast cancer patients. METHODS: Fifty patients with local recurrence or distant metastases after their treatment for breast cancer were selected for our study. RESULTS: These patients constituted 16.9% (50/296) of all the patients with breast cancer who were treated during the investigation period. Survival was correlated with the lymph node status (p = 0.036) and the disease free interval (DFI) (p < 0.001), but patient survival was not correlated with the patient's age (p = 0.586), the tumor type (p = 0.360), tumor grade (p = 0.353), tumor size (p = 0.886), extensive intraductal component (EIC) (p = 0.295), lymphatic invasion (p = 0.880), estrogen receptor (ER) status (p = 0.408), androgen receptor (AR) status (p = 0.386), the HER-2/neu expression (p = 0.291), the operative methods (p = 0.880), adjuvant therapy (p = 0.551) and metastatic organs and recurrence (p = 0.070). The overall median length of the DFI was 25.9 months. The 16 dead patients (32.0%) had a shorter mean DFI (19.7 months) than the mean DFI (28.8 months) of the 34 live patients (68.0%). The overall 5-year survival rate was 10.0%. CONCLUSION: We found the clinicopathological features of the presenting primary tumors that predicted a worse clinical outcome with recurrence or metastases, and these factors can be used in these types of cases as indicators for the prognosis.
Breast Neoplasms* ; Breast* ; Estrogens ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Prognosis ; Receptors, Androgen ; Recurrence* ; Survival Rate

PURPOSE: In this study we evaluated the significance of false positive screening bone scintigraphy (BS) in primary invasive breast cancer patients. Lymphatic vessel invasion (LVI), estrogen receptor (ER), progesterone receptor (PR), nuclear grade, histology grade, epidermal growth factor receptor (EGFR) and C-erb-B2 values were examined in terms of their abilities to predict the accuracy of abnormal BS. We also examined the incidence of bone metastasis in primary invasive breast cancer patients according to the 1988 and 2003 AJCC classifications. METHODS: A retrospective review was performed on 2,044 primary invasive breast cancer patients that had received BS screening, and who were treated by mastectomy or breast conserving surgery at the Seoul National University Hospital between Jan 1995 and Jul 2003. Abnormal screening BS results were divided into "less suspicious" and "highly suspicious" groups. Patient's stages according to the 1988 AJCC classification were reclassified according to the 2003 AJCC classification. Bone metastasis was confirmed by further radiological examination or follow-up BS. All statistical analyses were two-tailed. RESULTS: The incidences of bone metastasis and an abnormal screening BS result were 1.7% (35/2,044) and 13.8% (283/2,044), respectively. The false positive rate of screening BS was 87.6% (248/283). LVI was the only significant predictive factor of bone metastasis in 283 of the abnormal BS patients (p <.001). c-erb-B2 showed no significance to predict bone metastasis in the "less suspicious" group, but was Bone is the most common site of distant metastasis in invasive breast cancer at the time of primary diagnosis. The vertebrae are the most common sites of bone metastasis and the ribs, skull, sternum and proximal long bones are also frequently involved. Bone metastases affect 8% of patients marginally significant in the "highly suspicious" group (p = .046). ER, PR, nuclear grade, histology grade, and EGFR showed no significance in terms of predicting the accuracy of an abnormal BS result. The incidences of bone metastasis were 0.6, 1.3 and 7.6% in stages I, II and III, respectively, according to the 1988 AJCC classification, while these incidences were 0.6, 0.7 and 5.8% according to the 2003 AJCC classification. CONCLUSION: The use of screening bone scintigraphy as a routine screening test is hard to justify due to its high false positive rate. LVI may be a useful factor in that it predicts the accuracy of an abnormal BS result. The incidences of bone metastasis in stages II and III were lower for the 2003 AJCC staging system.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Lymphatic Vessels ; Mass Screening* ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Radionuclide Imaging* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies ; Ribs ; Seoul ; Skull ; Spine ; Sternum

PURPOSE: The c-met protein, known as the hepatocyte growth factor (HGF) receptor, is a transmembrane 190 kDa heterodimer having tyrosine kinase activity, and it is encoded by the c-met oncogene. The HGF/c-met signaling pathway has been shown to demonstrate various cellular responses including mitogenic, proliferative, morphogenic and angiogenic activities. Although HGF and c-met are known to be expressed in a variety of organs and they play important roles in signal transduction, studies on its expression and its correlation to the clinicopathological parameters of breast cancer are very rare. METHODS: In this study, we examined the c-met mRNA and the c-met protein expression by utilizing RT-PCR and immunohistochemical methods for 50 cases of invasive ductal carcinomas (IDCs) and 20 cases of normal breast tissues. RESULTS: The c-met mRNA amplification was detected in 35 cases of IDCs (70%), but not in the normal tissues. The c-met protein overexpression was detected in 27 cases of IDCs (54%) and 2 cases of normal breast tissue (10%). Both the mRNA amplification and protein overexpression rates were significantly higher in tumor than in the normal breast tissue. The c-met mRNA amplification showed a tendency to increase in an invasive cancer and nodal metastasis. The c-met protein overexpression was significantly correlated with the well differentiated grade of tumor and it showed a tendency to decrease in the metastatic tumors. The concordance between both the mRNA amplification and protein expressions were not observed. CONCLUSION: These results suggest that the HGF/c-met signal pathway may be associated with the development of breast cancer. c-met mRNA amplification may play important roles both in tumor progression and metastasis. c-met protein overexpression may contribute to the morphogenesis of well-differentiated tumor.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Hepatocyte Growth Factor ; Morphogenesis ; Neoplasm Metastasis ; Oncogenes ; Protein-Tyrosine Kinases ; RNA, Messenger ; Signal Transduction

PURPOSE: Among the many biological parameters of breast cancer, the p53 and HER-2/neu genes, which are located on the chromosome 17, and their gene products have been studied extensively by many researchers in regard their relation to the prognosis. The aim of this study was to evaluate the prognostic significance of the coexpression of p53 and HER-2/neu in breast cancer. METHODS: Formalin-fixed, paraffin-embedded tissues from 126 patients with invasive breast cancer were immunostained for p53 and HER-2/neu. Other prognostic parameters such as the patients' age, tumor size, lymph node metastasis, histologic grade, the presence of estrogen receptor (ER), and progesterone receptor (PgR) were evaluated. The patients' outcome was analyzed according to the expression of p53 and HER-2/neu as well as to the other prognostic factors. RESULTS: Among the 126 patients, p53 and HER-2/neu were positive in 46 (36.5%) and 33 (26.2%) patients. According to the expression of p53 and HER-2/neu, the patients were classified into three groups; group 1: negative expression for both factors (n = 63), and group 2: positive expression for either one of the factors (n = 47), and group 3: positive expression for both factors (n = 16). The median follow-up period was 50+/-11.1 months. On the Kaplan-Meier analysis, p53 and HER-2/neu were both related to the 5-year disease free survival rate (DFSR). Group 3 showed a significantly lower 5-year DFSR than did group 2 (66.2% vs. 85.2%, respectively, p = 0.05) and the group 1 (66.2% vs. 94.0%, respectively, p = 0.01). The multivariate analysis indicated that lymph node metastasis, ER, PgR, p53 and HER-2/neu expressions were significantly related to the patients'5-year DFSR. CONCLUSION: The expression of p53 and HER-2/neu was related to the 5-year DFSR of breast cancer, and the coexpression of p53 and HER-2/neu was found to have a more significant prognostic value than either one of these two parameters alone.
Breast Neoplasms* ; Breast* ; Chromosomes, Human, Pair 17 ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis* ; Receptors, Progesterone