Occult breast carcinoma presenting with axillary lymph node metastases: follow-up of eleven patients.
ABSTRACT Breast carcinoma presenting with axillary metastases and no clinically apparent primary tumor in the breast is an uncommon form of stage IIdisease. The methods of diagnosis and treatment of these patients are not established. We present our eleven treated cases of occult carcinoma and discuss the issues of evaluation and management.
Eleven patients with occult breast carcinoma (OBC) presenting between January, 1985 and April, 1998 at the National Shikoku Cancer Center were evaluated clinically and with immunohistochemical staining. Immunohistochemical staining was performed using the Envision method. The primary antibodies for gross cystic disease fluid protein-15 (GCDFP-15), estrogen receptor (ER) and progesterone receptor (PR) were used.
Nine patients underwent mastectomy. Breast-conserving surgery was performed in one patient. One patient did not receive any operation for the breast. No primary tumor was found among three of nine cases receiving mastectomy. Some adjuvant therapies after the operation were performed in eight cases. Follow-up ranged from 5 to 310 months (median, 54 months), and the five-year disease free survival rate was 62.5%. There were eight GCDFP-15 positive cases (72.7%) and four ER and/or PR positive cases (36.4%).
GCDFP-15 is useful for confirming the primary site of breast carcinoma. Ultrasonography, computed tomography, and magnetic resonance imaging are thought to be good for detecting occult primary tumors. The incidence of OBC is still unclear, but it is possible that these patients need to be treated as typical stage II patients.
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ABSTRACT: In some patients with a history of breast cancer who also have masses in the lung, making a clinical distinction between primary pulmonary neoplasia and pulmonary metastasis of mammary carcinoma may be impossible. To ascertain whether immunohistologic studies could contribute to resolving this problem, the authors undertook a prospective study of 30 cases showing synchronous or metachronous adenocarcinomas in these two sites. A predefined panel of antibodies--as derived from published antigenic catalogs for breast and lung cancer--was applied to each case. Tumors were interpreted as metastases if they were positive for gross cystic disease fluid protein-15, estrogen receptor protein, or S-100 protein. Conversely, primary adenocarcinomas of the lung were defined by their expression of carcinoembryonic antigen and a lack of the other three determinants. Using these criteria, 15 lesions were classified as metastatic; 11 were categorized as primary pulmonary adenocarcinomas; and 4 cases were indeterminate in origin. Responses to corresponding therapeutic protocols generally supported the validity of the immunohistologic diagnoses; 8 of 15 patients treated for metastatic breast cancer were well at least contact, as were 5 of 11 patients who received therapy for primary carcinoma of the lung. These data suggest that immunohistology plays a useful role in distinguishing mammary from pulmonary adenocarcinomas.American Journal of Clinical Pathology 08/1993; 100(1):27-35. · 2.88 Impact Factor
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ABSTRACT: Recommended surveillance for BRCA1 and BRCA2 mutation carriers includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in mutation carriers has not been established. The purpose of the present study was to compare breast magnetic resonance imaging (MRI) with ultrasound, mammography, and physical examination in women at high risk for hereditary breast cancer. A total of 196 women, aged 26 to 59 years, with proven BRCA1 or BRCA2 mutations or strong family histories of breast or ovarian cancer underwent mammography, ultrasound, MRI, and clinical breast examination on a single day. A biopsy was performed when any of the four investigations was judged to be suspicious for malignancy. Six invasive breast cancers and one noninvasive breast cancer were detected among the 196 high-risk women. Five of the invasive cancers occurred in mutation carriers, and the sixth occurred in a woman with a previous history of breast cancer. The prevalence of invasive or noninvasive breast cancer in the 96 mutation carriers was 6.2%. All six invasive cancers were detected by MRI, all were 1.0 cm or less in diameter, and all were node-negative. In contrast, only three invasive cancers were detected by ultrasound, two by mammography, and two by physical examination. The addition of MRI to the more commonly available triad of mammography, ultrasound, and breast examination identified two additional invasive breast cancers that would otherwise have been missed. Breast MRI may be superior to mammography and ultrasound for the screening of women at high risk for hereditary breast cancer.Journal of Clinical Oncology 09/2001; 19(15):3524-31. · 18.04 Impact Factor
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ABSTRACT: To test the possibility of immunohistochemical differentiation of cytostatically treatable metastatic breast carcinomas from other metastatic adenocarcinomas of unknown primary site, we studied a total of 328 metastatic adenocarcinomas including 35 bronchogenic, 26 pancreatic, 25 colonic, 39 gastric, 45 renal, 29 ovarian and 129 breast carcinomas with a panel of 13 commercially available monoclonal antibodies. The expression of gross cystic disease fluid protein 15 and/or oestrogen or progesterone receptors had a sensitivity of 0.83, a specificity of 0.93 and a predictive accuracy of 0.92 for carcinomas of the breast against all other carcinomas. Excluding ovarian carcinomas, this combination had a sensitivity, specificity and predictive accuracy for mammary carcinomas of 0.83, 0.98 and 0.98, respectively. Carcinoembryonic antigen and/or cytokeratin 20 identified bronchogenic, gastric, pancreatic and colorectal carcinomas versus breast carcinomas lacking gross cystic disease fluid protein 15 and oestrogen or progesterone receptors with a sensitivity, specificity and predictive accuracy of 0.82, 0.99 and 0.95, respectively. Vimentin differentiates renal cell carcinomas from gross cystic disease fluid protein 15 and oestrogene or progesterone receptor negative breast carcinomas with a sensitivity, specificity and predictive accuracy of 0.93, 0.82 and 0.84. Thus, it should be possible to differentiate most metastatic mammary carcinomas from metastatic adenocarcinomas of other common primary sites, even if the former lack expression of gross cystic disease fluid protein 15 and oestrogen or progesterone receptors.Histopathology 10/1996; 29(3):233-40. · 2.86 Impact Factor