Nipple Adenoma of the Breast: Case Report of Uncommon Benign Tumor and Brief Review of the Literature

Introduction: Neoadjuvant chemotherapy for breast cancer over the last several years is being utilized with increasing frequency. Neoadjuvant therapy can potentially downstage advanced regional disease, increasing the likelihood of negative surgical margins. This study analyzes the utilization and outcomes of neoadjuvant chemotherapy for breast cancer at a single institution.

Methods: A retrospective chart review was performed at the Jacqueline M Wilentz Breast Center in Long Branch, New Jersey. All patients from 2010 to present that underwent neoadjuvant chemotherapy for breast cancer were analyzed. The initial biopsy pathology, initial staging workup, response to therapy, operation, surgical pathology reports were studied. Chi square analysis was then used to identify factors more likely to yield a pathologic complete response. Finally, outcomes in patients that did and did not have a pathologic complete response were examined.

Results: The most common indications for neoadjuvant therapy for advanced regional disease and Her2 positive status. The tumor was successfully downstaged in 29 of 46 patients (63.0%), with 13 (28.3%) achieving pathologic complete response. The major predictors of pathologic complete response were chemotherapy regimen and Her2 status, as 12 of 21 patients (57.1%) patients with amplified Her2 and 8 of 12 (66.7%) patients receiving TCHP therapy achieving pCR. Predictive factors of residual disease included triple negative status and treatment with ACT chemotherapy. Pathologic complete response was predictive of favorable prognosis, as no patient that achieved a pCR had recurrence, local or distant, within the time frame of this study. Factors predictive of recurrence included residual nodal disease or residual tumor T3 or greater.

Conclusion: In our retrospective study, neoadjuvant chemotherapy successfully downstages patients in the majority of patients. The patients that were able to derive the most benefit from neoadjuvant therapy were those with Her2 amplified tumors, and those that underwent therapy with TCHP. Achievement of pCR incurred a favorable prognosis.

Histiocytoid breast carcinoma (HBC) is a rare type of breast cancer with a controversial histogenesis, generally considered to be a variant of invasive lobular carcinoma. It comprises fewer than 0.3% of breast cancer cases. Published reports on this neoplasm are sparse and there exists a significant diagnostic challenge when differentiating these tumors from other tumors with similar presentations. Paget’s disease of the breast comprises up to 3% of all breast malignancies. The majority of Paget’s disease cases are associated with ductal carcinoma in situ, with bilateral, multifocal, and synchronous pathology rarely reported. While bilateral presentation of invasive lobular carcinoma is well documented, synchronous and metachronous forms are rare. We present a case of a 20-year-old female with bilateral invasive histiocytoid lobular breast carcinoma and concurrent massive bilateral Paget’s disease of the breast. The goal of this manuscript is to explore possible pathologic associations and to clarify diagnostic parameters based on current literature.

Primary angiosarcoma of the breast is uncommon and only diagnosed in roughly 0.04% of all malignant breast tumors. Only 20% of these cases are primary malignancies while the remaining are complications of radiation therapy. Diagnosis is difficult because it tends to mimic benign characteristics on mammogram and histology. Although it can appear benign, breast angiosarcoma is an aggressive, malignant tumor with a poor prognosis. Radiologic imaging along with immunostaining with Factor VIII and CD31 can confirm the presence of angiosarcoma. Currently, surgery is the only treatment option that improves the clinical outcome of the disease, with little help from chemotherapy.

Mammary Paget’s disease (MPD) of the breast is a rare form of breast cancer. It accounts for a very small percentage of breast cancers in women, and much less in men It rarely occurs as an isolated entity and is usually associated with carcinoma in situ or invasive adenocarcinoma in most cases. In situ histology is seen in one third of the cases. Paget’s disease is rarely diagnosed in people under the age of 45. Paget’s disease affects people of all ethnic and racial groups. However, people of Asian descent are less likely to be affected. Surgical treatment of Paget’s disease (radical or conservative) is controversial. There is no established standardized treatment, and treatment decisions are based on other associated conditions. There is currently no evidence that either surgical approach (conservative surgery or mastectomy) improves survival. Prognosis depends on the presence of a palpable mass and the invasiveness of the cancer. We present a case of a 37-year-old woman who presented with recurrent mixed ductal lobular carcinoma associated with Paget’s disease. Paget’s disease diagnosis was completely established based on cytology material sampling only. The patient was treated with bilateral mastectomy with no nipple sparing. The patient was followed for four years with no evidence of metastasis or recurrence.

• Background: Breast MRI is a valuable tool, especially for women with dense breasts, but its visualization of all local lymph nodes is limited.

• Purpose: To demonstrate a breast MRI technique using a body coil on the back in addition to a breast surface coil to improve imaging of the breast and locoregional lymph nodes.

• Materials and Methods:

  • Breast MRI performed with a dedicated surface coil AND a second coil on the back.

  • Prone position.

  • High spatial resolution ("MIO Breast MRI").

  • Total examination time: 8:32 minutes for the breast MRI portion.

  • Included T2 measurement and dynamic T1 sequences (before and twice after 5 ml gadobutrol – a first-pass technique).

  • Additional coronal fat-suppressed T1 VIBE DIXON sequence:

    • 52 slices, 3mm thickness

    • Matrix 320 x 240

    • TR 4.2ms, TE 1.34/2.57ms

    • FOV 420mm

    • Measurement time: 16 seconds

• Results: The "sandwich technique" (breast coil + body coil) enabled detection of breast carcinomas AND imaging of axillary, infra-, supraclavicular, and parasternal lymph nodes. Total measurement time was 8:48 minutes (8:32 breast MRI + 16 seconds for lymph nodes). Optional lymph node imaging before contrast agent administration could be done in an additional 16 seconds.

• Conclusion: Combining breast and body surface coils provides high-quality breast MRI and sufficient imaging of all locoregional lymph nodes in under 10 minutes. This is particularly useful for preoperative local MR staging.