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1. Esses KM, Hagmaier RM, Blanchard SA, Lazarchick JJ, Riker AI: Carcinosarcoma of the breast: two case reports and review of the literature. Cases J; 2009;2(1):15
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  • [Title] Carcinosarcoma of the breast: two case reports and review of the literature.
  • Carcinosarcoma of the breast, often referred to as metaplastic carcinoma of the breast, is a rare malignancy with two distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component.
  • Clinically, carcinosarcoma of the breast is an aggressive breast cancer.
  • The prognosis for carcinosarcoma of the breast is less favorable compared to more common types of breast cancer such as infiltrating ductal or lobular carcinoma.
  • Currently, the evaluation of breast carcinoma includes hormone receptor analysis of the tumor tissue, with those positive for estrogen or progesterone responding better to both hormonal and chemotherapy.Trastuzumab (Herceptin(R)) is available as an adjunct treatment for tumors which over-express the HER2/neu gene.
  • Typically, metaplastic carcinomas of the breast do not express the estrogen or progesterone receptors and do not over-express the HER2/neu oncogene.
  • As a result of this "triple negative" phenotype, such tumors tend to be more aggressive and are unlikely to respond to targeted therapy with Herceptin.
  • The epidermal growth factor receptor HER-1/EGFR protein is expressed in the majority of metaplastic carcinomas and thus may serve as a potential therapeutic target for EGFR inhibitors such as gefitinib and cetuximab.
  • The two cases we describe exemplify the aggressive nature of carcinosarcoma of the breast and support the findings that this tumor type does not express the common receptors found in other breast carcinomas.
  • These case reports also emphasize the need for investigating the role for blockade of the HER-1/EGFR receptor with targeted therapies when found to be over-expressed in the primary tumor.


2. Spigel JJ, Evans WP, Grant MD, Langer TG, Krakos PA, Wise DK: Male inflammatory breast cancer. Clin Breast Cancer; 2001 Jul;2(2):153-5
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  • [Title] Male inflammatory breast cancer.
  • A case of a 48-year-old male with an inflammatory breast cancer is used to illustrate this uncommon malignancy.
  • The physical examination of thickening and erythema made the clinical diagnosis.
  • Mammographic findings of increased density in the right breast with coarsened stroma and an underlying mass confirmed the clinical findings.
  • The sonographic evaluation revealed a 2-cm ill-defined hypoechoic mass.
  • The pathologic examination of the mastectomy specimen showed an infiltrating duct cell carcinoma with lobular features.
  • Male breast cancer afflicts 1500 men each year.
  • [MeSH-major] Breast Neoplasms, Male / pathology. Carcinoma, Ductal, Breast / pathology
  • [MeSH-minor] Gynecomastia / pathology. Humans. Inflammation / drug therapy. Male. Middle Aged. Ultrasonography, Mammary


3. Zhou M, Johnson N, Gruner S, Ecklund GW, Meunier P, Bryn S, Glissmeyer M, Steinbock K: Clinical utility of breast-specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient. Am J Surg; 2009 Feb;197(2):159-63
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  • [Title] Clinical utility of breast-specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient.
  • BACKGROUND: Breast-specific gamma imaging (BSGI) is a functional imaging modality that has comparable sensitivity but superior specificity compared with magnetic resonance imaging, yielding fewer false-positive results and thereby improving clinical management of the newly diagnosed breast cancer patient.
  • METHODS: A retrospective review was performed from 2 community-based breast imaging centers of newly diagnosed breast cancer patients in whom BSGI was performed as part of the imaging work-up.
  • RESULTS: A total of 138 patients (69 invasive ductal carcinoma, 20 invasive lobular carcinoma, 32 ductal carcinoma in situ, and 17 mixtures of invasive ductal carcinoma, invasive lobular carcinoma, or ductal carcinoma in situ and other) were reviewed.
  • Twenty-five patients (18.1%) had a positive BSGI study at a site remote from their known cancer or more extensive disease than detected from previous imaging.
  • Fifteen patients (10.9%) were positive for a synchronous or more extensive malignancy in the same or contralateral breast.
  • Findings converted 7 patients to mastectomy, 1 patient to neoadjuvant chemotherapy, and 7 patients were found to have previously undetected contralateral cancer.
  • The positive predictive value for BSGI was 92.9%.
  • CONCLUSIONS: BSGI detected additional or more extensive malignancy in the same or contralateral breast in 10.9% of newly diagnosed breast cancer patients.
  • BSGI provides accurate evaluation of remaining breast tissue in newly diagnosed breast cancer patients with few false-positive readings.
  • [MeSH-major] Breast Neoplasms / radionuclide imaging

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  • (PMID = 19185109.001).
  • [ISSN] 1879-1883
  • [Journal-full-title] American journal of surgery
  • [ISO-abbreviation] Am. J. Surg.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 971Z4W1S09 / Technetium Tc 99m Sestamibi
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4. De Cesare A, Burza A, Fiori E, Bononi M, Volpino P, Leone G, Crocetti A, Cangemi V: Assessment of surgical treatment in elderly patients with breast cancer. Tumori; 2008 May-Jun;94(3):314-9
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  • [Title] Assessment of surgical treatment in elderly patients with breast cancer.
  • AIMS AND BACKGROUND: The incidence of breast cancer increases with advancing age and in clinical practice approximately 50% of new cases occur in women over the age of 65 years.
  • Although breast cancer in elderly patients presents more favorable biological characteristics than similar-stage cancer in younger women, disease control still remains uncertain and is becoming a major health problem.
  • PATIENTS AND METHODS: Between 1984 and 2006, 133 patients aged over 65 with operable breast cancer underwent surgical treatment.
  • Patients with ductal or lobular carcinoma in situ, bilateral breast cancer or a previous malignancy were excluded.
  • Breast-conserving surgery was performed in patients with early breast cancer (T1, T2 < 2.5 cm), while most patients with advanced tumors (T2 >2.5 cm, T3, T4) were treated by modified radical mastectomy.
  • RESULTS: The pathological stage was I in 44, IIA in 54, IIB in 18, IIIA in 10 and IIIB in 7 patients.
  • Eighty-nine patients underwent adjuvant therapy (chemotherapy, hormonal therapy).
  • After a median follow-up of 96 months (range, 5-266), disease progression was observed in 21 patients (15.8%).
  • The overall mortality from breast cancer was 11%, whereas the cancer-unrelated mortality was 9%.
  • CONCLUSION: There is no evidence that breast cancer has a more favorable prognosis in the elderly and surgical procedures should be carried out as has been established in younger women.
  • However, in the absence of serious comorbid disease, they are able to withstand standard multimodal treatment options as well as do younger patients.
  • [MeSH-major] Breast Neoplasms / pathology. Breast Neoplasms / surgery. Mastectomy
  • [MeSH-minor] Aged. Aged, 80 and over. Axilla. Biomarkers, Tumor / analysis. Carcinoma in Situ / surgery. Carcinoma, Ductal, Breast / surgery. Carcinoma, Lobular / surgery. Disease Progression. Female. Follow-Up Studies. Humans. Lymphatic Metastasis. Neoplasm Staging. Receptors, Estrogen / analysis. Receptors, Progesterone / analysis. Retrospective Studies. Treatment Outcome

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  • (PMID = 18705397.001).
  • [ISSN] 0300-8916
  • [Journal-full-title] Tumori
  • [ISO-abbreviation] Tumori
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Receptors, Estrogen; 0 / Receptors, Progesterone
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5. Paciucci PA, Raptis G, Bleiweiss I, Weltz C, Lehrer D, Gurry R: Neo-adjuvant therapy with dose-dense docetaxel plus short-term filgrastim rescue for locally advanced breast cancer. Anticancer Drugs; 2002 Sep;13(8):791-5
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  • [Title] Neo-adjuvant therapy with dose-dense docetaxel plus short-term filgrastim rescue for locally advanced breast cancer.
  • Neo-adjuvant, dose-dense docetaxel, 100 mg/m(2) every 2 weeks x 4 cycles, was administered to 12 patients with locally advance breast cancer (LABC) (10 stage IIIa and three stage IIIb).
  • Eligibility requirements included a PS 0-2, normal hepatic and renal function, and radiologic absence of metastatic disease.
  • Filgrastim [granulocyte colony stimulating factor (G-CSF)] was started 1 day after chemotherapy and was given for 6 days.
  • Complete blood counts were determined weekly.
  • The median age was 45 (range 34-73) and pre-treatment pathology revealed poorly differentiated infiltrating duct carcinoma in 11 and infiltrating lobular cancer in one, with positive ER/PR status in five.
  • Nine patients had a major clinical tumor response with five PR and four pathologic complete responses (pCR rate of 33%).
  • Three patients (of whom two with stage IIIb) had progressive disease and went on to receive neo-adjuvant therapy with AC.
  • There was one instance of grade 3 hematologic toxicity (neutropenic fever in one G-CSF non-compliant patient).
  • There were two instances of grade 3 extra-hematologic toxicity: one patient had severe pain and one had treatment-related fatigue.
  • Despite the small size of our study, we believe that dose-dense neo-adjuvant docetaxel is well tolerated and its activity warrants confirmation in a larger number of patients.
  • [MeSH-major] Antineoplastic Agents / administration & dosage. Breast Neoplasms / drug therapy. Granulocyte Colony-Stimulating Factor / administration & dosage. Paclitaxel / administration & dosage. Paclitaxel / analogs & derivatives. Taxoids
  • [MeSH-minor] Adult. Aged. Female. Filgrastim. Humans. Middle Aged. Neoadjuvant Therapy. Recombinant Proteins

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  • (PMID = 12394262.001).
  • [ISSN] 0959-4973
  • [Journal-full-title] Anti-cancer drugs
  • [ISO-abbreviation] Anticancer Drugs
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Recombinant Proteins; 0 / Taxoids; 143011-72-7 / Granulocyte Colony-Stimulating Factor; 15H5577CQD / docetaxel; P88XT4IS4D / Paclitaxel; PVI5M0M1GW / Filgrastim
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6. Rakha EA, Gill MS, El-Sayed ME, Khan MM, Hodi Z, Blamey RW, Evans AJ, Lee AH, Ellis IO: The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology. Breast Cancer Res Treat; 2009 Mar;114(2):243-50
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  • [Title] The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology.
  • Although invasive ductal (IDC) and lobular (ILC) breast carcinomas are well characterised in the literature, the biological and clinical significance of mixed tumours with both ductal and lobular components has not been investigated.
  • In the current study, we have examined a well-characterised series of breast carcinoma with a long term follow-up that comprised 140 mixed tumours, 2170 IDC and 380 pure ILC.
  • RESULTS: Mixed tumours constituted 3.6% of all cases.
  • The majority (59%) of the mixed tumours were grade 2 compared to 33% in IDC and 88% in ILC.
  • Positive lymph nodes (LN) were found in 41% and definite vascular invasion (VI) in 26% of the cases.
  • DCIS was detected in 123 (89%) and LCIS in 43 (31%) (both DCIS and LCIS were found in 39 cases).
  • The majority of tumours were predominantly (>50 of tumour area) of ductal type (57%).
  • When compared to pure IDC, mixed tumours showed an association with lower grade, ER positivity and lower frequency of development of distant metastases.
  • When compared to pure ILC, mixed tumours showed an association with higher grade, positive LN metastasis, VI and development of regional metastasis.
  • There was an association between histologic type of carcinoma in LN metastasis and the predominant histologic type of the primary tumour.
  • Mixed tumours showed metastatic patterns similar to that of ILC with frequent metastasis to bone.
  • No clinically meaningful differences in survival were found between these mixed carcinomas and pure IDC or ILC of the breast or between mixed tumours with predominantly ductal or lobular phenotype.
  • [MeSH-major] Breast Neoplasms / pathology. Carcinoma, Ductal, Breast / pathology. Carcinoma, Intraductal, Noninfiltrating / pathology. Carcinoma, Lobular / pathology
  • [MeSH-minor] Adult. Aged. Biomarkers, Tumor / metabolism. Female. Follow-Up Studies. Humans. Middle Aged. Neoplasm Invasiveness. Neoplasm Recurrence, Local / diagnosis. Neoplasm Recurrence, Local / drug therapy. Prognosis. Retrospective Studies. Survival Rate

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  • (PMID = 18404368.001).
  • [ISSN] 1573-7217
  • [Journal-full-title] Breast cancer research and treatment
  • [ISO-abbreviation] Breast Cancer Res. Treat.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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7. Schneider-Kolsky ME, Hart S, Fox J, Midolo P, Stuckey J, Hofman M, Ganju V: The role of chemotherapeutic drugs in the evaluation of breast tumour response to chemotherapy using serial FDG-PET. Breast Cancer Res; 2010;12(3):R37
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  • [Title] The role of chemotherapeutic drugs in the evaluation of breast tumour response to chemotherapy using serial FDG-PET.
  • INTRODUCTION: The aims of this study were to investigate whether drug sequence (docetaxel followed by anthracyclines or the drugs in reverse order) affects changes in the maximal standard uptake volume (SUVmax) on [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) during neoadjuvant chemotherapy in women with locally advanced breast cancer.
  • METHODS: Women were randomly assigned to receive either drug sequence, and FDG-PET scans were taken at baseline, after four cycles and after eight cycles of chemotherapy.
  • Tumour response to chemotherapy was evaluated based on histology from a surgical specimen collected upon completion of chemotherapy.
  • Thirty-one received docetaxel followed by anthracyclines (Arm A) and 29 received drugs in the reverse order (Arm B).
  • Most women (83%) had ductal carcinoma and 10 women (17%) had lobular or lobular/ductal carcinoma.
  • All but one tumour were downstaged during therapy.
  • Overall, there was no significant difference in response between the two drug regimens.
  • Sensitivity, specificity, accuracy and positive and negative predictive values were highest in women in Arm B.
  • CONCLUSIONS: Our results show that SUVmax uptake by breast tumours during chemotherapy can be dependent on the drugs used.
  • Care must be taken when interpreting FDG-PET in settings where patients receive varied drug protocols.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Breast Neoplasms / diagnosis. Carcinoma, Ductal, Breast / diagnosis. Carcinoma, Lobular / diagnosis. Fluorodeoxyglucose F18. Positron-Emission Tomography. Radiopharmaceuticals
  • [MeSH-minor] Adult. Aged. Anthracyclines / administration & dosage. Chemotherapy, Adjuvant. Female. Humans. Middle Aged. Neoadjuvant Therapy. Receptor, ErbB-2 / metabolism. Receptors, Estrogen / metabolism. Receptors, Progesterone / metabolism. Survival Rate. Taxoids / administration & dosage. Treatment Outcome

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  • (PMID = 20565953.001).
  • [ISSN] 1465-542X
  • [Journal-full-title] Breast cancer research : BCR
  • [ISO-abbreviation] Breast Cancer Res.
  • [Language] eng
  • [Publication-type] Journal Article; Randomized Controlled Trial
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Anthracyclines; 0 / Radiopharmaceuticals; 0 / Receptors, Estrogen; 0 / Receptors, Progesterone; 0 / Taxoids; 0Z5B2CJX4D / Fluorodeoxyglucose F18; 15H5577CQD / docetaxel; EC 2.7.10.1 / Receptor, ErbB-2
  • [Other-IDs] NLM/ PMC2917032
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8. Sullivan PS, Apple SK: Should histologic type be taken into account when considering neoadjuvant chemotherapy in breast carcinoma? Breast J; 2009 Mar-Apr;15(2):146-54
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  • [Title] Should histologic type be taken into account when considering neoadjuvant chemotherapy in breast carcinoma?
  • Neoadjuvant chemotherapy is becoming the standard of care in locally advanced breast cancers.
  • However, most patients do not have a complete pathologic response, and it is unclear how this impacts survival and whether histologic subtype or chemotherapeutic histologic changes play a role.
  • We retrospectively identified 49 cases of invasive breast carcinoma treated with neoadjuvant chemotherapy (40 ductal, nine lobular) and examined histologic and biologic features of ductal and lobular carcinoma before and after chemotherapy.
  • Patients with lobular carcinomas presented at a later age and had lower grade tumors that were more likely estrogen and progesterone receptor positive.
  • Ductal carcinomas had a greater frequency of HER-2/neu amplification and increased Ki-67 rate.
  • After chemotherapy, none of the lobular carcinomas had complete pathologic response compared with 28% of the ductal carcinomas (p = 0.01).
  • Lobular carcinomas had more lymph node metastases.
  • At the time of clinical follow-up, no lobular carcinomas had evidence of disease.
  • Only one lobular carcinoma case had any histologic changes after chemotherapy compared with 37-68% of ductal carcinomas (p < 0.05).
  • In ductal carcinomas, higher grade and negative estrogen receptor expression before chemotherapy and presence of foam cell clusters, HER-2/neu expression, and absence of lymphatic or vascular space invasion after chemotherapy correlated with pathologic response (p < 0.05).
  • Decreased Ki-67 rate after chemotherapy correlated with survival (p = 0.024).
  • Breast biomarker status changed in 9% of all lobular carcinomas and 19% of all ductal carcinomas.
  • Lobular carcinomas respond poorly to neoadjuvant chemotherapy as evidence by lack of complete pathologic response and rare histologic tissue response.
  • [MeSH-major] Breast Neoplasms / drug therapy. Breast Neoplasms / pathology. Chemotherapy, Adjuvant / methods
  • [MeSH-minor] Adult. Aged. Carcinoma, Intraductal, Noninfiltrating / drug therapy. Carcinoma, Intraductal, Noninfiltrating / pathology. Carcinoma, Lobular / drug therapy. Carcinoma, Lobular / pathology. Female. Humans. Immunohistochemistry. Ki-67 Antigen / analysis. Middle Aged. Neoplasm Invasiveness. Receptors, Estrogen / analysis. Receptors, Progesterone / analysis. Retrospective Studies. Tumor Suppressor Protein p53 / analysis






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