Breast Carcinoma, Metastatic to the Eye:
65 year old woman, presented with loss of vision.
This is an Infiltrating Lobular Carcinoma, with pleomorphic features. The tumor infiltrates the stroma in cords and sheets. Malignant cells are moderately pleomorphic and exhibit atypical nuclei with vesicular chromatin pattern, and irregular nuclear membranes. 25 mitoses per 10 HPF are identified. Microcalcifications are present. Focal lymphovascular invasion is identified. Lobular carcinoma in-situ is identified. E-cadherin immunostain is performed and negative in the tumor cells supporting the lobular origin of the tumor.
This breast cancer unfortunately presented as metastasis to an orbit, encasing the orbital nerve with complete vision loss. The patient had a 5cm lesion in the breast, with three positive axillary lymph nodes. This patient required mastectomy with axillary lymph node dissection, followed by radiation and chemotherapy for the treatment of primary and metastatic disease.
Breast cancer is the second leading cause of death after lung cancer. The United States has the highest incidence rate. Breast cancer is one hundred times more common in women than men.
Warning Signs of Breast Cancer:
- Lump in breast
- A change in the shape of size of the breast.
- Redness or dimpling of the breast.
- Soreness or itchiness of the breast.
- Retraction, changes in appearance or color, or discharge of the nipple.
- Lump(s), swelling or pain in the armpit.
Warning signs may be absent with very small lesions.
Possible Risk Factors:
- Aged 55 years and older
- Excessive alcohol consumption
- Oral contraceptive use
- Not breast feeding
- Family history of breast cancer
- Genetics (e.g. Mutation in BRCA 1 and BRCA2 genes)
- High hormone levels
- Sedentary lifestyle
The presence of risk factors does not mean cancer is guaranteed. Many cancer patients don’t have apparent risk factors at all.
Breast cancer is subdivided into two main categories:
- In-situ Carcinoma
- Invasive Carcinoma
Subtypes of Invasive Breast Cancer
Some cancer subtypes are more aggressive than others and may involve both breasts.
- Ductal Carcinoma; most common type and constituting 65-80% of breast carcinomas
- Lobular Carcinoma; with high frequency of bilateral carcinomas
- Papillary Carcinoma; rare tumor
- Medullary Carcinoma; favorable prognosis
- Adenoid Cystic Carcinoma; favorable prognosis
- Mucinous Carcinoma
- Secretory Carcinoma
- Squamous cell carcinoma
- Metaplastic carcinoma
- Apocrine Carcinoma
- Glycogen-Rich Carcinoma
- Cribriform Carcinoma
- Tumor Size (<2 cm, 2-5 cm, >5 cm)
- Histologic Grade (Low, Intermediate, High)
- Lymph Node Stage
- Receptor Status (ER, PR and HER2neu)
- DNA Analysis
Prognosis is a prediction of the outcome and disease-free survival. Predicting the patient survival, outcome, prognosis and treatment is very dependent on the prognostic factors and accordingly classified as: Excellent, Good, Moderate, Poor and Very Poor.
Breast cancer can be deadly, if discovered late with metastasis to different organs. This aggressive disease can be diagnosed and treated early with appropriate screening. Screening is different from patient to patient, according to their risk factors as well as their family history. The purpose of the screening is early detection of premalignant conditions and cancer at an early stage.
Premalignant lesions, or invasive malignancy diagnosed earlier and completely treated, have a much better prognosis and may not need further treatment other than follow-up and regular screening. However, patients with risk factors who are not screened properly may develop more serious conditions. Delayed excision of premalignant lesions may result in transformation to an invasive malignancy that may metastasize to other areas of the body. In advanced invasive malignancy, further surgery- as well as chemotherapy and radiation- is needed.
Preventive measures may help decrease the incidence of breast cancer; however, they do not completely prevent it.
Discover and Potentially Prevent Breast Cancer by:
- Regular self exams
- Mammogram, Ultrasound and Genetic Testing as clinically indicated
- Biopsy, or excision of any suspicious lesions
- Adopt a healthier lifestyle: Eat well, exercise regularly and maintain a healthy weight
- Limit alcohol consumption and smoking
- Avoid taking hormone supplementation unless necessary
- Utilize profilactic treatment in patients with a history of familial breast cancer
Treatment of Breast Cancer:
Stage 1: Excellent prognosis; treated with surgery+radiation
Stages 2 and 3: Intermediate to poor prognosis; treated with surgery+chemotherapy+radiation
Stage 4: Very poor prognosis; metastatic; treated with a combination of surgery, chemotherapy+radiation+targeted therapy.
Case read and contributed by Hanan Ayoub, MD.
All information is intended for general knowledge only, and is not a substitute for medical advice or treatment for specific medical conditions. The laboratory cannot and does not give medical advice. The information contained on this site is presented in summary form only and is intended to provide broad consumer understanding, and knowledge of pathology services. This information should not be considered complete and should not be used in place of a visit, call or consultation with a health care provider.