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Coexisting DCIS and phyllodes breast tumors in Young Chinese women: Case series

Sun, Luona; Zhu, Roger; Ginter, Paula; Malik, Manmeet; Sung, Kap-Jae; Hughes, J Melissa; Siegel, Beth; Tsai, Jacqueline
INTRODUCTION/BACKGROUND:Breast cystosarcoma phyllodes tumors are rare and can be benign or malignant. All sub-divisions of phyllodes tumor-benign, borderline and malignant, can harbor carcinomas, although the incidence is extremely rare. METHODS:We present two nonconsecutive cases of coexisting ductal carcinoma in situ (DCIS) and phyllodes breast tumors in young patients. METHODS & CASE PRESENTATION/UNASSIGNED:Retrospective review of two patient's medical record was performed. CASE 1: 30-year-old female underwent excisional biopsy for 3.48 cm mass found on ultrasound. Pathology revealed malignant phyllodes tumor with positive margin. On re-excision, patient was found to have 1.5 cm area of ductal carcinoma in situ (DCIS) with positive margin. Patient then underwent re-reexicision of DCIS with negative margin. Patient underwent chemotherapy and tamoxifen for three years without evidence of disease. CASE 2: 30-year-old female presented with 1.3 cm lesion found on ultrasound which core needle biopsy revealed a fibroepithelial tumor. Patient subsequently underwent excision biopsy which found 1.5 cm benign phyllodes tumor and 3.5 mm DCIS within the phyllodes tumor with negative margins. Patient declined additional chemotherapy or hormonal therapy and is currently considering mastectomy. CONCLUSION/CONCLUSIONS:Phyllodes tumors are rare and ones with a coexisting carcinoma are even less frequently encountered. The treatment plan can change upon diagnosis of the carcinoma via the pathology. Treatment should be guided by the type and stage of carcinoma detected which may include additional surgical resection and lymph node sampling.
PMCID:6389554
PMID: 30798095
ISSN: 2210-2612
CID: 5053892

Germline SDHA mutations in children and adults with cancer

Dubard Gault, Marianne; Mandelker, Diana; DeLair, Deborah; Stewart, Carolyn R; Kemel, Yelena; Sheehan, Margaret R; Siegel, Beth; Kennedy, Jennifer; Marcell, Vanessa; Arnold, Angela; Al-Ahmadie, Hikmat; Modak, Shakeel; Robson, Mark; Shukla, Neerav; Roberts, Stephen; Vijai, Joseph; Topka, Sabine; Kentsis, Alex; Cadoo, Karen; Carlo, Maria; Latham Schwark, Alicia; Reznik, Ed; Dinatale, Renzo; Hechtman, Jaclyn; Borras Flores, Ester; Jairam, Sowmaya; Yang, Ciyu; Li, Yirong; Bayraktar, Erol Can; Ceyhan-Birsoy, Ozge; Zhang, Liying; Kohlman, Wendy; Schiffman, Joshua; Stadler, Zsofia; Birsoy, Kivanc; Kung, Andrew; Offit, Kenneth; Walsh, Michael F
Mutations in succinate dehydrogenase complex genes predispose to familial paraganglioma-pheochromocytoma syndrome (FPG) and gastrointestinal stromal tumors (GIST). Here we describe cancer patients undergoing agnostic germline testing at Memorial Sloan Kettering Cancer Center and found to harbor germline SDHA mutations. Using targeted sequencing covering the cancer census genes, we identified 10 patients with SDHA germline mutations. Cancer diagnoses for these patients carrying SDHA germline mutations included neuroblastoma (n = 1), breast (n = 1), colon (n = 1), renal (n = 1), melanoma and uterine (n = 1), prostate (n = 1), endometrial (n = 1), bladder (n = 1), and gastrointestinal stromal tumor (GIST) (n = 2). Immunohistochemical staining and assessment of patient tumors for second hits and loss of heterozygosity in SDHA confirmed GIST as an SDHA-associated tumor and suggests SDHA germline mutations may be a driver in neuroblastoma tumorigenesis.
PMCID:6071569
PMID: 30068732
ISSN: 2373-2873
CID: 3639902

Excellent Long-term Breast Preservation Rate After Accelerated Partial Breast Irradiation Using a Balloon Device

Mann, Justin M; Osian, Adrian D; Brandmaier, Andrew; Yan, Weisi; Sung, Kap-Jae; Siegel, Beth; Fink, Simon; Kaplan, Barry; Fulman, Malvin; Wu, Guojiao; Christos, Paul; Nori, Dattatreyudu; Ravi, Akkamma
BACKGROUND: Accelerated partial breast irradiation (APBI) using a balloon device has been well tolerated. A recent retrospective population-based study showed an increase in the rate of subsequent mastectomy for patients who undergo APBI compared with whole breast radiation therapy. Our aim was to analyze the long-term results of patients treated with APBI at our institution to determine the salvage mastectomy and locoregional recurrence rates and cosmesis outcomes. MATERIALS AND METHODS: After institutional review board approval, we conducted a retrospective review of 111 patients treated from June 2003 to October 2014 at our institution for early-stage breast cancer using a balloon device. After lumpectomy and nodal staging, the patients underwent APBI with high-dose rate iridium-192 brachytherapy. A computed tomography-based 3-dimensional plan was created, and a dose of 34 Gy in 10 fractions was given twice daily, 6 hours apart, over 5 days. Follow-up examinations were performed 2 to 3 times annually by either a surgeon and/or a radiation oncologist. Annual mammograms were obtained. The patients included postmenopausal women with node-negative early-stage invasive ductal carcinoma with a tumor size < 3 cm (n = 93) or ductal carcinoma in situ (n = 18). Cosmesis was evaluated using the Harvard criteria, as excellent, good, fair, or poor. RESULTS: At a median follow-up period of 66 months (range, 1-139 months) after completing treatment, with a minimum of 5 years of follow-up data for 62 patients (55.9%), the incidence of ipsilateral breast tumor recurrence (IBTR) was 2.7% (n = 3) and the incidence of ipsilateral axilla nodal recurrence was 1.8% (n = 2). The ipsilateral breast preservation rate was 97.3%. The salvage mastectomy rate was 2.7% (n = 3), and the 5-year salvage mastectomy-free rate was 98.7% (95% confidence interval, 91.0%-99.8%). No distant failure developed, and no breast cancer-related deaths occurred. The 5-year overall survival rate was 91.7% (95% confidence interval, 83.2%-96.0%), and the 10-year breast cancer-specific survival rate was 100%. Of the 3 cases of IBTR, 2 were estrogen receptor negative (P = .076). The mean interval to IBTR was 78.7 +/- 27.5 months from treatment completion. A significant association was noted between African-American ethnicity and IBTR (P = .0398). Excellent to good cosmesis was observed in 98.1% of the patients. The maximum skin dose (mean value) for patients with excellent, good, and fair cosmesis was 302.2 Gy, 315.4 Gy, and 372.5 Gy (88.9%, 92.7%, and 109.5% of the prescription dose), respectively. The maximum skin dose was < 340 Gy (100% of the prescribed dose) in 69.9% of patients with excellent to good cosmesis. CONCLUSION: The long-term follow-up data of patients receiving APBI with a balloon device showed a low salvage mastectomy rate with durable long-term breast preservation. Excellent local control with good cosmesis was noted in these postmenopausal patients treated with APBI.
PMID: 26948247
ISSN: 1938-0666
CID: 2046452

The Association Between Lobular Involution and Histology in Older Women With Nonpalpable Lesions [Meeting Abstract]

Checka, Cristina; Chun, Jennifer; Schnabel, Freya; Darvishian, Farbod; Axelrod, Deborah; Siegel, Beth; Roses, Daniel
ISI:000289681900037
ISSN: 1068-9265
CID: 132518

Mammographic Density and Lobular Involution in Older Women with Abnormal Breast Imaging [Meeting Abstract]

Checka, CM; Chun, J; Schnabel, FR; Darvishian, F; Lee, J; Bergknoff, Y; Axelrod, DM; Siegel, BM; Roses, DF
ISI:000272920702198
ISSN: 0008-5472
CID: 106458

Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up

Bernik, Stephanie F; Troob, Scott; Ying, Benjamin L; Simpson, Scott A; Axelrod, Deborah M; Siegel, Beth; Moncrief, Robyn M; Mills, Christopher; Aziz, Mohamed
BACKGROUND: Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions. METHODS: A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised. RESULTS: Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%. CONCLUSIONS: When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention
PMID: 18723154
ISSN: 0002-9610
CID: 93491

Acute toxicity of high-dose-rate intracavitary brachytherapy with the MammoSite applicator in patients with early-stage breast cancer

Richards, Gregory M; Berson, Anthony M; Rescigno, John; Sanghavi, Seema; Siegel, Beth; Axelrod, Deborah; Bernik, Stephanie; Scarpinato, Vincent; Mills, Christopher
BACKGROUND: Intracavitary brachytherapy with the MammoSite applicator as the sole radiation treatment in breast-conserving therapy is an option for women with early-stage breast cancer; we evaluated the acute toxicities associated with this treatment method. METHODS: Thirty-one patients with 32 stage I or II breast carcinomas underwent breast-conserving therapy, which included lumpectomy with negative margins, sentinel node biopsy, or axillary dissection, followed by brachytherapy with the MammoSite applicator. Acute radiation skin complications were graded on the day of radiotherapy completion and at weeks 2, 4, 6, and 12 after radiation treatment. Cosmesis was graded on the Harvard Scale at all follow-ups. RESULTS: The median follow-up was 11 months (range, 4-15 months). Twenty-seven of the 31 patients were treated with the device as the sole method of radiotherapy. No acute toxicities occurred during the 5 days of treatment. Nineteen patients (68%) had no to mild acute skin reactions, and 25% developed bright erythema and patchy moist desquamation. Two patients (7%) developed confluent moist desquamation within the first 4 weeks (grade 3); this healed by week 12. All skin reactions were localized to the area overlying the balloon. Sixteen percent (5 of 32) of all breasts with implants developed infection. Cosmesis was good to excellent in 86% of cases. CONCLUSIONS: Most acute skin toxicities were mild. Our infection rate was higher than in prior studies that used interstitial brachytherapy. Cosmesis was good to excellent in most patients. Breast brachytherapy with the MammoSite catheter was well tolerated; further investigations of breast brachytherapy with this system are warranted
PMID: 15249336
ISSN: 1068-9265
CID: 69414

Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable, or nonpalpable breast cancer

Kumar, Rakesh; Jana, Suman; Heiba, Sherif I; Dakhel, Mahmoud; Axelrod, Deborah; Siegel, Beth; Bernik, Stephanie; Mills, Christopher; Wallack, Marc; Abdel-Dayem, Hussein M
Multicentric or multifocal breast cancer is considered as one of the limitations for sentinel lymph node (SLN) localization. We did a retrospective analysis to evaluate the success rate, sensitivity, accuracy, and negative predictive values of SLN localization in multicentric or multifocal breast lesions. METHODS: Fifty-nine patients with multifocal or multicentric breast lesions proven by either fine-needle aspiration (19/59), core biopsy (39/59), or lumpectomy (8/59) underwent SLN localization. Of these patients, 46 had SLN localization by both radiocolloid and blue dye, and 13 had SLN localization by radiocolloid alone. Approximately 10 MBq (99m)Tc-labeled unfiltered sulfur colloid in 0.3-0.4 mL were injected intradermally over the 1 or 2 breast tumor locations 2-4 h before surgery. During surgery, vital blue dye was injected intraparenchymally in 4-6 places around the tumor. All lymph nodes with counts of >10 times that of the background counts, whether or not blue dye positive, and all blue dye-positive lymph nodes, whether or not radiocolloid positive, were excised and labeled accordingly. All lymph nodes underwent frozen sectioning and were examined by hematoxylin and eosin and immunohistologic (cytokeratin) staining. RESULTS: Of the 59 patients, 48 had axillary lymph node dissection irrespective of the results of pathologic examination of the SLN. The success rate, sensitivity, negative predictive value, and accuracy were 93%, 100%, 100%, and 100% using the radiocolloid probe, 87%, 100%, 100%, and 100% using blue dye, and 93.5%, 100%, 100%, and 100% using combined methods, respectively. Concordance between blue dye and radiocolloid was 91% (the incidence of the number of sentinel nodes detected was 37.5%, 30.3%, 10.7%, and 21.4% for 1, 2, 3, and 4 or more lymph nodes, respectively). Metastatic lymph node involvement was found in 39.5% of patients. CONCLUSION: The sentinel node localization approach showed a high negative predictive value in breast cancer patients with multifocal or multicentric lesions, contrary to the common belief of significant false-negative results in these patients
PMID: 12515869
ISSN: 0161-5505
CID: 69415

Do we have to revise inclusion criteria for sentinel node localization in breast cancer? [Meeting Abstract]

Jana S; Kumar R; Heiba S; Dakhel M; Axelrod D; Siegel B; Bernik S; Mills C; Abdel-Dayem HM
ORIGINAL:0006510
ISSN: 1619-7070
CID: 93578

Affect of excisional biopsy (Bx) of breast mass on negative predictive value (NPV), accuracy (ACC) or Success Rate (SR) of sentinel node (SN) localization [Meeting Abstract]

Jana, S; Dakhel, M; Axelrod, D; Siegel, B; Bhaskaran, S; Mills, C; Heiba, S; Wallack, M; Luo, J; Sadek, S; Abdel-Dayem, H
ISI:000170528300627
ISSN: 0340-6997
CID: 93510