Primary osteogenic sarcoma of the breast is a rare clinical entity with few cases described in the literature. Unfortunately, the prognosis for these patients is poor when compared to invasive carcinomas of the breast. We report a case of a 58-year-old female who developed a primary osteogenic sarcoma of the breast five years after being treated for invasive carcinoma of the ipsilateral breast without the use of radiotherapy.
Introduction: Accurate assessment of the status of the axillary lymph nodes is crucial in staging, planning treatment and determining prognosis in breast cancer. Traditionally this involved total axillary dissection. Recently, in order to decrease morbidity, the technique of Sentinel Lymph Node Biopsy (SLNB) has virtually replaced standard Axillary Lymph Node Dissection (ALND) in T1 and T2 disease with non-palpable axillary lymph nodes. The two commonly applied techniques for SLNB are radio-colloid and dye injection. In our low resource environment, we planned to use the methylene blue dye injection technique to determine the percentages of false negative as well as true positive and true negatives in order to judge the accuracy and guide applicability of this technique in our setting.
Methods:We prospectively analysed data from consecutive proven T1 and T2 female breast cancer patients with non-palpable axillary lymph nodes between January and December 2018 at our institution. Exclusion criteria were patients receiving neo-adjuvant treatment, previous breast or axillary radiation, previous axillary surgery and multi-focality. All patients meeting inclusion criteria were assessed by determining the percentage of true positive and negative as well as false negative (by comparing histology of the excised sentinel lymph node with the histology of at least 10 non-sentinel nodes on permanent sections). Demographics such as age of patient, grade of carcinoma, histological subtype and size of tumours were also analysed.Results: 47 patients were studied. T1 stage accounted for 24% of the patients and T2 for 76%. The incidence of axillary metastases (both sentinel and axillary nodes) was found to be 57% (27 of 47). All patients with positive sentinel nodes had at least 2 positive non-sentinel axillary nodes. True negative was 100% (20 of 20) and true positive was also 100% (27 of 27). There were no false negatives.
Conclusion:In comparison with other SLNB validation studies, we report a very accurate technique of SLNB in our setting. Our data suggest SLNB using methylene blue dye can be used as a reliable alternative to the costly technique of radioactive colloid.
Metaplastic breast cancer is rare and aggressive, accounting for only 0.2% of all breast cancers with a survival ranging from 40-65%. A recent case from our institution posed many diagnostic and management challenges prompting a review of our local ten-year experience with this cancer and a review of the literature to compare the behaviour of this cancer in a developing country and considering guidelines for management.The incidence is higher with what appears to be a better prognosis in our patient population. Early diagnosis and treatment may be responsible for the apparent better outcome in our patient population. Successful treatment consists of surgery, radiotherapy and with comparable results from both breast conservation and modified radical mastectomy. Preoperative biopsy does not usually yield the correct diagnosis so most patients undergo axillary node dissection even though the mode of spread is supposed to be primarily hematogenous.
Primary small cell breast carcinoma represents less than 1% of breast cancers. Due to its rarity, there are no uniformly accepted guidelines for treatment. Its prognosis is varied being generally regarded as worse than that of most breast cancers and it poses unique diagnostic challenges. We present a case of primary small cell breast cancer, rationale for our management strategies with reference to the published literature to serve as a guide to the management of this rare cancer of the breast.
Dermatofibrosarcoma protuberans (DFSP) is an extremely rare cutaneous neoplasm of the dermal layer of the skin and is histologically classified as a sarcoma. DFSP itself has an incidence of 0.8 cases per million annually. It accounts for 1% of all soft tissue sarcomas and less than 0.1% of all malignancies. DFSP has a high rate of local recurrence especially if there are positive margins on excision, but only up to 4% develop metastasis. Most reported cases are located in the trunk, extremities and head especially scalp. However, DFSP of the breast is very rare with very few reported in the literature. We report a case of a 33-year-old woman who presented with a histological diagnosis of DFSP of the breast, based on incisional biopsy. We report this case which highlights the important aspects in evaluating DFSP in the breast as well as its treatment.
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