Clinicopathological and therapeutic features of metaplastic carcinoma of the breast: a study of 15 cases

Background: Metaplastic carcinoma of the breast is a rare entity containing a mixture of malignant epithelial and mesenchymal elements. The World Health Organization only recognized it as a distinct pathological entity since 2000. The aim of this study is to better characterize this rare disease.Methods: We reviewed retrospectively 15 cases of metaplastic carcinoma of the breast treated in our institute between 1994 and 2015. We analyzed clinical, histological, therapeutic and evolutive data.Results: All patients were females ranging from 29 to 75 years old (median, 50). Tumor size ranged from 20 to 150 mm (median, 72 mm). The Treatment consisted of radical mastectomy in 14 cases, often combined with post-operative radiation and/or chemotherapy. There were 8 cases of carcinosarcoma, 4 cases of spindle cell carcinoma and 3 cases of squamous cell carcinoma. Follow-up data were available on 12 patients. The median follow-up was 47 months (range, 10 to 146 months). Definitive nodal metastases were identified in 6 cases. One patient developed a local recurrence. Extranodal metastases occurred in 3 patients. Three patients died at median interval of 20 months (range, 13-30). Eight patients were alive with no evidence of recurrent or metastatic disease (median, 47 months) and one patient was alive with metastatic disease.Conclusions: Based on this series, metaplastic breast carcinoma is characterized by a large tumor size at presentation, a low frequency of nodal metastases and a high proportion of triple negativity. Our series is consistent with the literature

In-Air Signature Verification System Based on Beta-Elliptical Approach and Fuzzy Perceptual Detector

Believing that biometrics trends are moving to distant and contactless mode, in-air signature verification is nowadays considered as one of the principal users biometric identification in contactless mode allowing users identification by drawing their handwritten signature in the air. In-air signature verification is used in many applications like access control and forensic analysis. In this regard, we propose a novel system for in-air signature verification using Beta stroke segmentation. The Beta-elliptical approach and the fuzzy perceptual detector are used for features extraction. The proposed system defines a specific data acquisition protocol and uses preprocessing steps to prepare data. Finally, the verification phase is done based on Dynamic Time Warping. To evaluate our proposed system, we have created two in-air signature datasets with and without the use of a transparent glass plate, which we make publicly available at https://ieee-dataport.org/documents/air-signature-databases, termed respectively In-Air Signature dataset (IAS dataset) and In-Air Signature dataset using Glass Plate (IASGP dataset). Our verification system demonstrates promising outcomes, yielding an Equal Error Rate (EER) of 1.25% when applied to the IAS dataset and an EER of 2.00% when applied to the IASGP dataset in the skilled-forgery scenario. Extensive evaluations were conducted on both the 3DAirSig and the DeepAirSig datasets. The results confirm that the proposed system has a good performance compared to existing in-air signature verification systems for both skilled-forgery and random-forgery scenarios

Paget’s Disease of the Female Breast: Clinical Findings and Management in 53 Cases at a Single Institution

Background: Mammary Paget’s disease is an uncommon form of primary breast cancer. The aim of this study is to assess our institution’s experience in its management. Methods:We retrospectively reviewed the medical records of 53 female patients with histologically confirmed Paget’s disease, treated at the Salah Azaïz Institute between 2001 and 2010. Results: There were palpable masses in 71.7% of cases, of which 90% revealed invasive carcinoma. Approximately 48% of underlying malignancies were multifocal/multicentric. Overall, invasive carcinoma accounted for 69.8% with a median tumor size of 40 mm, high grade in 62.2%, and negative hormone receptor in 47.6% of cases. There was only one case with direct dermis invasion among those with no underlying invasive carcinoma. After a median follow-up of 45 months, 49% of patients presented with relapse/progression and 47.1% died from their disease. Median overall survival was 67 months, whereas disease-free survival was 65 months. Tumor and node advanced clinical stages correlated with poor survival, as well as the presence of invasive carcinoma with additional negative impacts of large tumor size and lymph node involvement. Tumor stage was the only independent indicator on multivariate analysis. Conclusion: The general trend for decreased incidence of Paget’s disease is noted parallel to earlier breast cancer diagnosis. Paget’s disease is at high risk of multifocal/multicentric underlying tumors. The presence of a palpable mass is almost pathognomonic of invasive neoplasm. The major challenge concerns aggressiveness of surgical procedures with breast and axilla preservation perspectives. Prognosis is mainly determined by that of an eventual underlying breast tumor

A Rare Coexistence: Breast Cancer, Pheochromocytoma and Von Recklinghausen Disease

Breast cancer associated with type-1 neurofibromatosis is a rare clinical entity. These patients have a higher risk of developing various types of cancers, especially tumors derived from the embryogenic neural crest, such as pheochromocytoma. This publication aims to add to the literature a rare association between Type-1 Neurofibromatosis, breast cancer, and pheochromocytoma.We present a rare case of a 51-year-old Tunisian woman with neurofibromatosis who was diagnosed with breast cancer and pheochromocytoma. The breast tumor was classified as T4b N1M0, and the discovery of the pheochromocytoma was incidental to thoracic-abdominal-pelvic CT. She underwent surgery to remove the adrenal gland and was referred to medical oncologists to receive chemotherapy for her breast cancer. Type-1 Neurofibromatosis disorder is a benign disease but can expose patients to numerous neoplasms. The challenging diagnosis at an early stage can worsen the prognosis and make medical care more difficult

Identifying accessible prognostic factors for breast cancer relapse: a case-study on 405 histologically confirmed node-negative patients

Abstract Background Histologically, node-negative breast cancer generally have a good prognosis. However, 10 to 30% of the cases present local relapses or metastasis. This group of people has high chances of remission if detected early. The aim of this study is to identify financial affordability for developing countries to adjust treatment. Methods We selected 405 patients with histologically confirmed node-negative breast cancer in our institution between January 2001 and December 2003. Patients with metastasis were excluded. The statistical analysis was conducted using SPSS ver. 18 (SPSS, Inc., Chicago, Illinois). Results The medial age was 51 years old. The medial tumor size was 35.4 mm. Clinically, 67.2% of the patients were staged cT2 and 63.2%, cN1i. Breast conservation was achieved in 41% of cases. In the histologic examination, the medial size was 30 mm. Grade III tumors were found in 50.1% of patients and positive hormonal receptors in 53.4%. The mean number of lymph nodes was 14. Eight patients had neoadjuvant chemotherapy. Adjuvant locoregional radiation and adjuvant chemotherapy were prescribed respectively in 70.6 and 64.4% of cases. 59.7% had adjuvant hormonal therapy. The follow-up showed 17.7% cases of relapse either locally or in a metastatic way in a mean time of 57.4 months. The disease-free survival at 5 years was 82.1%, and the overall survival for the same period was 91.5%. The histologic tumor size and the grade and number of lymph node dissected were shown to be influencing the disease-free survival. Radiation therapy and hormone therapy showed improved disease-free survival and overall survival. Conclusion Our study found interesting results that may help personalize the treatment especially for patient living in underdeveloped countries, but further studies are needed to evaluate those and more accessible prognostic factors for a more accessible healthcare

Fertility-Sparing Surgery in Infiltrative Mucinous Carcinoma of the Ovary

Introduction: Mucinous ovarian carcinoma is often diagnosed early and can affect young patients. The preservation of the female reproductive organ is one of the critical issues, especially for nulliparous women. This case report aims to reconsider the safe outcome of fertility-sparing surgery for infiltrative type mucinous ovarian carcinoma. Case Presentation: A 28-year-old woman with a right mucinous ovarian carcinoma, infiltrative subtype stage IA was treated by right salpingo-oophorectomy, omentectomy, and lymph nodes staging. A 5-year follow-up showed no signs of relapse, and she completed two full-term natural pregnancies. Conclusion: Conservative surgery is a crucial matter for this patient category. The infiltrative type has a poorer prognosis, but few papers have reported the outcome and the safety of fertility-sparing surgery in this context

Inferior vena cava leiomyosarcoma: vascular reconstruction is not always mandatory

Leiomyosarcoma (LMS) of inferior vena cava is a rare and aggressive tumor, arising from the smooth muscle cells in the vessel wall. A large complete surgical resection is the essential treatment. The need of vascular reconstruction is not always mandatory. It’s above all to understand the place of the reconstruction with artificial vascular patch prosthetics of vena cave after a large resection of the tumor. We rapport two cases of LMS of inferior vena cava in two women who underwent successful large resection of tumor and lower segment of inferior vena cava. In first case, reconstruction of the inferior vena cava was not performed because of the development of venous collaterals derivation. In the second case reconstruction was done using Dacron interposition graft. The necessity of a large resection in management of primary leiomyosarcoma of vena cave makes sometimes unavoidable the sacrifice of a portion of the vena. Indeed, a better comprehension of the development of venous derivation may render unnecessary the reconstruction.The Pan African Medical Journal. 2016;24