Journal of Pathology and Translational Medicine

Original Article

The Prognostic Impact of Synchronous Ipsilateral Multiple Breast Cancer: Survival Outcomes according to the Eighth American Joint Committee on Cancer Staging and Molecular Subtype: Jinah Chu, Hyunsik Bae, Youjeong Seo, Soo Youn Cho, Seok-Hyung Kim, Eun Yoon Cho; J Pathol Transl Med. 2018;52(6):396-403. Published online October 23, 2018; DOI: https://doi.org/10.4132/jptm.2018.10.03

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Background
In the current American Joint Committee on Cancer staging system of breast cancer, only tumor size determines T-category regardless of whether the tumor is single or multiple. This study evaluated if tumor multiplicity has prognostic value and can be used to subclassify breast cancer.
Methods
We included 5,758 patients with invasive breast cancer who underwent surgery at Samsung Medical Center, Seoul, Korea, from 1995 to 2012.
Results
Patients were divided into two groups according to multiplicity (single, n = 4,744; multiple, n = 1,014). Statistically significant differences in lymph node involvement and lymphatic invasion were found between the two groups (p < .001). Patients with multiple masses tended to have luminal A molecular subtype (p < .001). On Kaplan-Meier survival analysis, patients with multiple masses had significantly poorer disease-free survival (DFS) (p = .016). The prognostic significance of multiplicity was seen in patients with anatomic staging group I and prognostic staging group IA (p = .019 and p = .032, respectively). When targeting patients with T1-2 N0 M0, hormone receptor–positive, and human epidermal growth factor receptor 2 (HER2)–negative cancer, Kaplan-Meier survival analysis also revealed significantly reduced DFS with multiple cancer (p = .031). The multivariate analysis indicated that multiplicity was independently correlated with worse DFS (hazard ratio, 1.23; 95% confidence interval, 1.03 to 1.47; p = .025). The results of this study indicate that tumor multiplicity is frequently found in luminal A subtype, is associated with frequent lymph node metastasis, and is correlated with worse DFS.
Conclusions
Tumor multiplicity has prognostic value and could be used to subclassify invasive breast cancer at early stages. Adjuvant chemotherapy would be necessary for multiple masses of T1–2 N0 M0, hormone-receptor-positive, and HER2-negative cancer.

Citations

Citations to this article as recorded by

Deep learning-based system for automatic prediction of triple-negative breast cancer from ultrasound images
Alexandre Boulenger, Yanwen Luo, Chenhui Zhang, Chenyang Zhao, Yuanjing Gao, Mengsu Xiao, Qingli Zhu, Jie Tang
Medical & Biological Engineering & Computing.2023; 61(2): 567. CrossRef
Multicentre prospective cohort study of unmet supportive care needs among patients with breast cancer throughout their cancer treatment trajectory in Penang: a PenBCNeeds Study protocol
Noorsuzana Mohd Shariff, Nizuwan Azman, Rohayu Hami, Noor Mastura Mohd Mujar, Mohammad Farris Iman Leong Bin Abdullah
BMJ Open.2021; 11(3): e044746. CrossRef
The subgross morphology of breast carcinomas: a single-institution series of 2033 consecutive cases documented in large-format histology slides
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Virchows Archiv.2020; 476(3): 373. CrossRef
Editorial for “Synchronous Breast Cancer: Phenotypic Similarities on MRI”
Uma Sharma
Journal of Magnetic Resonance Imaging.2020; 52(1): 309. CrossRef
Synchronous Multiple Breast Cancers—Do We Need to Reshape Staging?
Minodora Onisâi, Adrian Dumitru, Iuliana Iordan, Cătălin Aliuș, Oana Teodor, Adrian Alexandru, Daniela Gheorghiță, Iulian Antoniac, Adriana Nica, Alexandra-Ana Mihăilescu, Sebastian Grădinaru
Medicina.2020; 56(5): 230. CrossRef
Molecular mechanism of triple‑negative breast cancer‑associated BRCA1 and the identification of signaling pathways
Feng Qi, Wen‑Xing Qin, Yuan‑Sheng Zang
Oncology Letters.2019;[Epub] CrossRef

Case Study

Isolated Mass-Forming IgG4-Related Cholangitis as an Initial Clinical Presentation of Systemic IgG4-Related Disease: Seokhwi Kim, Hyunsik Bae, Misun Choi, Binnari Kim, Jin Seok Heo, Ho Seong Kim, Seung Hee Choi, Kee-Taek Jang; J Pathol Transl Med. 2016;50(4):300-305. Published online January 11, 2016; DOI: https://doi.org/10.4132/jptm.2015.12.01

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92 Download
5 Web of Science
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Abstract PDF

IgG4-related disease (IgG4-RD) may involve multiple organs. Although it usually presents as diffuse organ involvement, localized mass-forming lesions have been occasionally encountered in pancreas. However, the same pattern has been seldom reported in biliary tract. A 61-year-old male showed a hilar bile duct mass with multiple enlarged lymph nodes in imaging studies and he underwent trisectionectomy under impression of cholangiocarcinoma. Gross examination revealed a mass-like lesion around hilar bile duct. Histopathologically, dense lymphoplasmacytic infiltration and storiform fibrosis were identified without evidence of malignancy. Immunohistochemical stain demonstrated rich IgG4-positive plasma cell infiltration. Follow-up imaging studies disclosed multiple enlarged lymph nodes with involvement of pancreas and perisplenic soft tissue. The lesions have been significantly reduced after steroid treatment, which suggests multi-organ involvement of systemic IgG4-RD. Here, we report an unusual localized mass-forming IgG4-related cholangitis as an initial presentation of IgG4-RD, which was biliary manifestation of systemic IgG4-related autoimmune disease.

Citations

Citations to this article as recorded by

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions
Haeryoung Kim, Kee-Taek Jang
Journal of Pathology and Translational Medicine.2020; 54(5): 367. CrossRef
Multivisceral IgG4-related disease presenting as recurrent massive gastrointestinal bleeding: a case report and literature review
Xuexue Deng, Ronghua Fang, Jianshu Zhang, Rongqiong Li
BMC Gastroenterology.2018;[Epub] CrossRef
Recent advances in understanding and managing IgG4-related disease
Anna R. Wolfson, Daniel L. Hamilos
F1000Research.2017; 6: 185. CrossRef

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