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Radiology. Cardiothoracic Imaging Jun 2023Myositis ossificans (MO) is an uncommon tumor characterized by a rapidly growing mass following a history of local trauma. Few cases of MO affecting the breast have been...
Myositis ossificans (MO) is an uncommon tumor characterized by a rapidly growing mass following a history of local trauma. Few cases of MO affecting the breast have been reported, and some were misdiagnosed as primary osteosarcoma of the breast or metaplastic breast carcinoma. The following case report presents a patient with a growing breast lump whose core biopsy result was suspicious for breast cancer. MO was diagnosed after analysis of the mastectomy specimen. This case highlights the importance of MO as a differential diagnosis of a growing soft-tissue mass after trauma to avoid unnecessary overtreatment. Myositis Ossificans, Osteosarcoma, Breast Cancer, Mastectomy, Heterotopic Ossification © RSNA, 2023.
PubMed: 37404791
DOI: 10.1148/ryct.230023 -
NPJ Breast Cancer Jun 2023Rare subtypes of triple-negative breast cancers (TNBC) are a heterogenous group of tumors, comprising 5-10% of all TNBCs. Despite accounting for an absolute number of... (Review)
Review
Rare subtypes of triple-negative breast cancers (TNBC) are a heterogenous group of tumors, comprising 5-10% of all TNBCs. Despite accounting for an absolute number of cases in aggregate approaching that of other less common, but well studied solid tumors, rare subtypes of triple-negative disease remain understudied. Low prevalence, diagnostic challenges and overlapping diagnoses have hindered consistent categorization of these breast cancers. Here we review epidemiology, histology and clinical and molecular characteristics of metaplastic, triple-negative lobular, apocrine, adenoid cystic, secretory and high-grade neuroendocrine TNBCs. Medullary pattern invasive ductal carcinoma no special type, which until recently was a considered a distinct subtype, is also discussed. With this background, we review how applying biological principals often applied to study TNBC no special type could improve our understanding of rare TNBCs. These could include the utilization of targeted molecular approaches or disease agnostic tools such as tumor mutational burden or germline mutation-directed treatments. Burgeoning data also suggest that pathologic response to neoadjuvant therapy and circulating tumor DNA have value in understanding rare subtypes of TNBC. Finally, we discuss a framework for advancing disease-specific knowledge in this space. While the conduct of randomized trials in rare TNBC subtypes has been challenging, re-envisioning trial design and technologic tools may offer new opportunities. These include embedding rare TNBC subtypes in umbrella studies of rare tumors, retrospective review of contemporary trials, prospective identification of patients with rare TNBC subtypes entering on clinical trials and querying big data for outcomes of patients with rare breast tumors.
PubMed: 37353557
DOI: 10.1038/s41523-023-00554-x -
NPJ Breast Cancer Jun 2023Chemoimmunotherapy with anti-programmed cell death 1/ligand 1 and cytotoxic chemotherapy is a promising therapeutic modality for women with triple-negative breast...
Chemoimmunotherapy with anti-programmed cell death 1/ligand 1 and cytotoxic chemotherapy is a promising therapeutic modality for women with triple-negative breast cancer, but questions remain regarding optimal chemotherapy backbone and biomarkers for patient selection. We report final outcomes from a phase Ib trial evaluating pembrolizumab (200 mg IV every 3 weeks) with either weekly paclitaxel (80 mg/m weekly) or flat-dose capecitabine (2000 mg orally twice daily for 7 days of every 14-day cycle) in the 1st/2nd line setting. The primary endpoint is safety (receipt of 2 cycles without grade III/IV toxicities requiring discontinuation or ≥21-day delays). The secondary endpoint is efficacy (week 12 objective response). Exploratory aims are to characterize immunologic effects of treatment over time, and to evaluate novel biomarkers. The trial demonstrates that both regimens meet the pre-specified safety endpoint (paclitaxel: 87%; capecitabine: 100%). Objective response rate is 29% for pembrolizumab/paclitaxel (n = 4/13, 95% CI: 10-61%) and 43% for pembrolizumab/capecitabine (n = 6/14, 95% CI: 18-71%). Partial responses are observed in two subjects with chemo-refractory metaplastic carcinoma (both in capecitabine arm). Both regimens are associated with significant peripheral leukocyte contraction over time. Response is associated with clinical PD-L1 score, non-receipt of prior chemotherapy, and the H&E stromal tumor-infiltrating lymphocyte score, but also by a novel 27 gene IO score and spatial biomarkers (lymphocyte spatial skewness). In conclusion, pembrolizumab with paclitaxel or capecitabine is safe and clinically active. Both regimens are lymphodepleting, highlighting the competing immunostimulatory versus lymphotoxic effects of cytotoxic chemotherapy. Further exploration of the IO score and spatial TIL biomarkers is warranted. The clinical trial registration is NCT02734290.
PubMed: 37344474
DOI: 10.1038/s41523-023-00541-2 -
BioRxiv : the Preprint Server For... Jun 2023Esophageal adenocarcinoma arises from Barrett's esophagus, a precancerous metaplastic replacement of squamous by columnar epithelium in response to chronic inflammation....
Esophageal adenocarcinoma arises from Barrett's esophagus, a precancerous metaplastic replacement of squamous by columnar epithelium in response to chronic inflammation. Multi-omics profiling, integrating single-cell transcriptomics, extracellular matrix proteomics, tissue-mechanics and spatial proteomics of 64 samples from 12 patients' paths of progression from squamous epithelium through metaplasia, dysplasia to adenocarcinoma, revealed shared and patient-specific progression characteristics. The classic metaplastic replacement of epithelial cells was paralleled by metaplastic changes in stromal cells, ECM and tissue stiffness. Strikingly, this change in tissue state at metaplasia was already accompanied by appearance of fibroblasts with characteristics of carcinoma-associated fibroblasts and of an NK cell-associated immunosuppressive microenvironment. Thus, Barrett's esophagus progresses as a coordinated multi-component system, supporting treatment paradigms that go beyond targeting cancerous cells to incorporating stromal reprogramming.
PubMed: 37333362
DOI: 10.1101/2023.06.08.544265 -
Journal of Cancer Research and... 2023Low-grade adenosquamous carcinoma of the breast is a rare variant of metaplastic mammary carcinoma. It shows indolent behavior contrary to the usual aggressive nature of...
Low-grade adenosquamous carcinoma of the breast is a rare variant of metaplastic mammary carcinoma. It shows indolent behavior contrary to the usual aggressive nature of metaplastic carcinomas and has a good prognosis despite being triple negative. Recurrence rates tend to be high and a consequence of incomplete excision. Although this variant has an infiltrative growth pattern, owing to its bland cytologic features, it is liable to be confused with benign sclerosing adenotic breast lesions. We present here a case of a 55-year-old postmenopausal female, who presented with a painless, mobile, hard, and nontender lump in the lower outer quadrant of the left breast, with normal overlying skin and nipple-areola complex. No associated axillary lymphadenopathy was seen. On mammography, a high-density mass of architectural distortion, characterized as BIRADS category 4C, was found. Core-needle biopsy showed haphazard glands lined by a double layer of epithelium and nests of squamoid cells arranged in an infiltrative fashion within a fibromyxoid stroma. On immunohistochemistry, tumor cells showed a lack of expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 receptor and were positive for CK 5/6 and CK7. There was counterintuitive, but characteristic positivity for myoepithelial markers calponin and CD 10 around the neoplastic nests and stromal cells expressed smooth muscle myosin. Subsequently, the patient underwent a wide local excision with free margins and sentinel lymph nodes were negative for tumor deposits. This patient remains well and free of recurrence well into follow-up.
Topics: Female; Humans; Middle Aged; Carcinoma, Adenosquamous; Breast; Breast Neoplasms; Mammography; Epithelium
PubMed: 37313920
DOI: 10.4103/jcrt.jcrt_1277_21 -
Cancers May 2023In this population-based study, we aim to identify factors that are influential on the survival outcome in MBC and investigate novel molecular approaches in personalized...
PURPOSE
In this population-based study, we aim to identify factors that are influential on the survival outcome in MBC and investigate novel molecular approaches in personalized disease management.
METHODS
The data of this study were collected from the SEER database from 2000-2018. A total of 5315 cases were extracted from the database. The data were evaluated for demographics, tumor characteristics, metastasis, and treatment. Survival analysis was completed by using SAS software for multivariate analysis, univariate analysis, and non-parametric survival analysis. The molecular data with the most common mutations in MBC were extracted from the Catalogue of Somatic Mutations in Cancer (COSMIC) database.
RESULTS
The mean age at the time of presentation was 63.1 with a standard deviation (SD) of 14.2 years. Most patients were White (77.3%) with 15.7% Black patients, 6.1% Asian or Pacific Islander, and 0.5% American Indian. Histologically, most of the reported tumors were grade III (74.4%); 37% of the cases were triple negative (ER-, PR- and HER2-), whereas the hormone status was unknown in 46% of the cases. Spread was localized in 67.3% of patients while 26.3% had regional spread and 6.3% had distant metastases. Most tumors were unilateral (99.9%) and between 20-50 mm in size (50.6%). The lungs were the most common site for distant metastasis at diagnosis (3.42%) followed by bone (1.94%), liver (0.98%), and brain (0.56%). A combination of surgery, chemotherapy, and radiation therapy was the most common treatment with a cause-specific survival rate of 78.1% (95% CI = 75.4-80.4). The overall survival rate at 5 years was 63.6% (95% confidence interval (CI) = 62.0-65.1) with a cause-specific survival of 71.1% (95% CI = 69.5-72.6). Cause-specific survival was found to be 63.2% (95% CI = 58.9-67.1) in Black patients as compared to 72.4% (95% CI = 70.1-74.1) in White patients. Black patients also presented with higher rates of grade III disease, distant metastasis, and larger tumor size. On multivariate analysis, age > 60, grade III+, metastasis, and tumor size > 50 mm were associated with worse survival. The most common mutations in MBC identified in COSMIC data were TP53, PIK3CA, LRP1B, PTEN, and KMT2C.
CONCLUSION
Though rare, MBC is aggressive, with poor prognosis associated with high-grade tumors, metastasis, tumor size over 50 mm, and advanced age at the time of presentation. Overall, Black women had worse clinical outcomes. MBC is difficult to treat and carries a poor prognosis that affects various races disproportionately. Continued enhancement of treatment strategies to foster more individualized care as well as continued enrollment in clinical trials are needed to improve outcomes among patients with MBC.
PubMed: 37296916
DOI: 10.3390/cancers15112954 -
Frontiers in Oncology 2023Gastric cancer is a malignant epithelial neoplasm of the stomach, including adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, undifferentiated carcinoma,...
Gastric cancer is a malignant epithelial neoplasm of the stomach, including adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, undifferentiated carcinoma, gastroblastoma and neuroendocrine neoplasms, without gastric metaplastic carcinoma. We describe a 69-year-old male patient with gastric cancer who presented with a novel, biphasic histologic morphology with one component consisting of poorly differentiated adenocarcinoma and the other component consisting of chondromyxoid matrix with adenocarcinoma transition to, between the two components without a spindle cell component. The histological morphology of this case is similar to matrix-producing metaplastic breast carcinoma. Therefore, we diagnose this case as gastric carcinoma with chondromyxoid matrix similar matrix-producing metaplastic breast carcinoma.
PubMed: 37274268
DOI: 10.3389/fonc.2023.1087241 -
Asian Journal of Surgery Oct 2023
Topics: Humans; Female; Breast; Carcinoma, Squamous Cell; Cell Differentiation; Breast Neoplasms; Biomarkers, Tumor
PubMed: 37268459
DOI: 10.1016/j.asjsur.2023.05.069 -
Cureus May 2023We report a rare case of pleomorphic adenoma (benign mixed tumor) of the breast in a 66-year-old female. A 5.5 cm hypoechoic mass with lobulated margins was noted on...
We report a rare case of pleomorphic adenoma (benign mixed tumor) of the breast in a 66-year-old female. A 5.5 cm hypoechoic mass with lobulated margins was noted on ultrasound. A biopsy showed an atypical cartilaginous lesion, leading to a subsequent segmental mastectomy, which was initially interpreted as metaplastic breast carcinoma. On the second review at our tertiary care center, a diagnosis of a pleomorphic adenoma was favored due to the circumscription and the benign epithelial component. Due to unfamiliarity with this entity, this neoplasm has occasionally been misdiagnosed clinically and even been overcalled on core needle biopsies. Careful clinical, radiological, and pathological correlation is required to avoid unnecessarily aggressive surgery, and a differential diagnosis of pleomorphic adenoma must be included in cases of well-demarcated breast masses showing myxoid or cartilaginous changes on core-needle biopsy.
PubMed: 37250610
DOI: 10.7759/cureus.38827 -
Metaplastic Carcinoma of the Breast: Case Series of a Single Institute and Review of the Literature.Medical Sciences (Basel, Switzerland) May 2023Metaplastic carcinoma of the breast (MpBC) is a very rare and aggressive type of breast cancer. Data focusing on MpBC are limited. The aim of this study was to describe... (Review)
Review
Metaplastic carcinoma of the breast (MpBC) is a very rare and aggressive type of breast cancer. Data focusing on MpBC are limited. The aim of this study was to describe the clinicopathological features of MpBC and evaluate the prognosis of patients with MpBC. Eligible articles about MpBC were identified by searching CASES SERIES gov and the MEDLINE bibliographic database for the period of 1 January 2010 to 1 June 2021 with the keywords metaplastic breast cancer, mammary gland cancer, neoplasm, tumor, and metaplastic carcinoma. In this study, we also report 46 cases of MpBC stemming from our hospital. Survival rates, clinical behavior, and pathological characteristics were analyzed. Data from 205 patients were included for analysis. The mean age at diagnosis was 55 (14.7) years. The TNM stage at diagnosis was mostly stage II (58.5%) and most tumors were triple negative. The median overall survival was 66 (12-118) months, and the median disease-free survival was 56.8 (11-102) months. Multivariate Cox regression analysis revealed that surgical treatment was associated with decreased risk of death (hazard ratio 0.11, 95% confidence interval 0.02-0.54, = 0.01) while advanced TNM stage was associated with increased risk of death (hazard ratio 1.5, 95% confidence interval 1.04-2.28, = 0.03). Our results revealed that surgical treatment and TNM stage were the only independent risk factors related to patients' overall survival.
Topics: Humans; Middle Aged; Female; Carcinoma, Ductal, Breast; Breast; Breast Neoplasms; Prognosis; Disease-Free Survival
PubMed: 37218987
DOI: 10.3390/medsci11020035