Helena Gervásio

Primary non-Hodgkin lymphoma and invasive ductal carcinoma in the same breast: a rare case report

Primary lymphoma of the breast is an unusual clinical entity. The coexistence in the same breast of an invasive ductal carcinoma is even rarer. We report a 69-year-old woman referred for further evaluation of a palpable mass in her right breast. She was diagnosed and treated for simultaneous primary lymphoma and invasive ductal carcinoma. Primary breast lymphoma should always be considered in the differential diagnosis of breast masses. The presence of both malignancies presents a challenge in treatment decisions.

Concurrent breast stroma sarcoma and breast carcinoma: a case report

IntroductionBreast cancer is one of the most important health problems in the world and affects a great number of women over the entire globe. This group of tumors rarely presents as bilateral disease and, when it does happen, normally occurs within the same histological type. We report a rare case of concurrent bilateral breast cancer with two different histology types, a breast carcinoma and a breast sarcoma, in a 42-year-old woman referred to our hospital.Case presentationA 42-year-old Caucasian woman admitted to our institute in August 1999, presented with a nodule in the left breast of 3.0 × 2.5 cm, and, in the right breast, one of 1.0 cm, suspected of malignancy and with a clinically negative armpit. Biopsies had revealed invasive mammary carcinoma (right breast) and sarcoma (left breast). She was submitted to bilateral modified radical mastectomy. A histological study showed an invasive mammary carcinoma degree II lobular pleomorphic type with invasion of seven of the 19 excised axillary nodes in the right breast and, in the left breast, a sarcoma of the mammary stroma, for which the immunohistochemistry study was negative for epithelial biomarkers and positive for vimentin. Later, she was submitted for chemotherapy (six cycles of 75 mg/m2 5-fluorouracil, epirubicin and cyclophosphamide) followed by radiotherapy of the thoracic wall and axillary nodes on the left. Hormone receptors were positive in the tumor of the right breast, and tamoxifen, 20 mg, was prescribed on a daily basis (five years) followed by letrozole, 2.5 mg, also daily (five years). She presented no sign of negative evolution in the last consultation.ConclusionThe risk of development of bilateral breast cancer is about 1% each year within a similar histological type, but it is higher in tumors with lobular histology. In this case, the patient presented, simultaneously, two histologically distinct tumors, thus evidencing a rare situation.

Association between bevacizumab-related hypertension and response to treatment in patients with metastatic colorectal cancer.

Background Bevacizumab has become standard of care as first-line treatment of metastatic colorectal cancer (mCRC), after proving increased response rates and improvement in survival outcomes. Hypertension (HTN) is a common complication of the treatment with bevacizumab and, owing to its close relation with antiangiogenic mechanism, may represent a clinical biomarker to predict the efficacy of the treatment. The aim of this study was to retrospectively evaluate if HTN grades 2 to 3 were correlated with response to treatment with bevacizumab in first line, as well as with improved progression-free survival (PFS) and overall survival (OS), in a series of patients with mCRC. Methods Retrospective evaluation of clinical records of patients with histologically proven mCRC, treated with bevacizumab as first-line treatment, between January 2008 and December 2013. Results 79 patients were evaluated. 51.9% of patients developed HTN G2-G3 during chemotherapy-bevacizumab treatment. In the group of patients who developed bevacizumab-related HTN, 73.2% showed response to treatment (complete response (CR)+ partial response (PR)) and 97.6% achieved disease control (CR, PR or stable disease) compared to 18.4% of patients with response and 63.2% with disease control in the group that did not (OR 12.08; 95% CI 4.13 to 35.29; p<0.001 responders vs non-responders; OR 20.8; 95% CI 2.56 to 168.91; p 0.005 controlled vs non controlled disease). The median OS was 28 months (22.7–33.3). Significant statistical difference was obtained in PFS between the two groups (p<0.001). In the group that developed bevacizumab-related HTN, the median OS was 33 months (25.7–40.3), and in the group that did not, it was 21 months (16.5–25.5) with no significant statistical difference between the two groups (p 0.114). Conclusions In this subset of patients, HTN G2-3 was predictive of response to treatment with bevacizumab and of PFS but not of OS.

PO70 ESTROGEN RECEPTOR AS A NEGATIVE PREDICTOR OF COMPLETE PATHOLOGICAL RESPONSE IN HER2 POSITIVE LOCALLY ADVANCED BREAST CANCER

from local records in a 3 year period. Information was collected on patient age, tumour hormone receptor status and timeframes to diagnosis of brachial plexopathy. The modalities used to confirm a diagnosis of brachial plexopathy were analysed. Results: 7 patients with metastatic breast cancer developed brachial plexopathy in a 3 year period. The median age at presentation was 62 years. 5 patients were found to have hormone receptor positive tumours and 2 patients had hormone insensitive tumours. The time interval to the development of brachial plexopathy in the hormone sensitive group varied from 9-24 years; median of 17 years. The 2 patients with hormone insensitive tumours developed brachial plexopathy within a much shorter timeframe; 2 and 4 years respectively. All patients underwent magnetic resonance imaging (MRI) to visualise the brachial plexus. In 4 patients, this was sufficient to confirm brachial plexus involvement by tumour. 3 of the patients required further investigation due to equivocal findings on MRI. In these cases one or more further modality was required, including positron emission tomography/computed tomography (PET/CT) and nerve conduction studies. Conclusion: Brachial plexopathy is uncommon. It is an important differential diagnosis if new symptoms develop in the upper limb. The condition should be considered even if the history of breast cancer is remote, especially if the patient’s original tumour was hormone sensitive. MRI allows for excellent visualisation of the brachial plexus and improved soft tissue resolution. However, our findings suggest the sensitivity of MRI for this condition is not reliable. MRI combined with PET/CT and/or nerve conduction studies offers higher diagnostic yield and improves specificity.