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| Year : 2010 | Volume
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| Issue : 4 | Page : 884-886 |
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| Pregnancy and lactation-associated breast carcinomas |
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Mary Mathew, Manna Valiathan, Lakshmi Rao
Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
Click here for correspondence address and email
| Date of Web Publication | 27-Oct-2010 |
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How to cite this article:
Mathew M, Valiathan M, Rao L. Pregnancy and lactation-associated breast carcinomas. Indian J Pathol Microbiol 2010;53:884-6 |
Sir,
Pregnancy-associated breast cancer is defined as breast cancer diagnosed during the gestation and lactation period or 1 year following birth. [1] The reported incidence by Wallack et al. in a series of 32 cases ranged from 0.2% to 3.8%. Traditionally, gestational breast carcinoma was viewed with unfavorable prognosis. Recent studies have proved that survival is equivalent in patients when matched with control subjects for stage, although pregnant patients have more advanced disease. [2] This may be attributed to the initial delay in diagnosis rather than the hormonal milieu of pregnancy. [1]
Four cases of carcinoma breast associated with lactational changes encountered in the past 2 years are documented. [Table 1]. All cases were diagnosed at different centers and the biopsies were sent for review and further management. None of the patients had undergone mammography or fine needle aspiration cytology.
Case 1
A 34-year-old lactating female presented with a breast lump of 3 months duration. The excised lump weighed 300 g and measured 11 cm x 9 cm x 4 cm. Grossly, the tumor was bosselated, grey-white in color and had a variegated appearance with slit-like spaces. Sections showed a tumor composed of fascicles of pleomorphic spindle cells with neoplastic osteoid admixed with osteoclast-like giant cells. A histological diagnosis of malignant phyllodes with osteosarcoma was made [Figure 1]. | Figure 1: Case 1 - Fascicles of pleomorphic malignant spindle cells. Inset - Malignant osteoid with multinucleated giant cells (H and E, ×400)
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Case 2
A 28-year-old female lactating for 1 year presented with lump in the breast of 1 month duration. Lumpectomy biopsy sent for review revealed nests of malignant spindle-shaped cells with pleomorphic vesicular nuclei arranged in fascicles entrapping lobules of benign acini with lactational changes. The mitotic rate was 21/10 hpf. Focal areas of malignant osteoid and cartilage were seen. A diagnosis of malignant phyllodes tumor with osteosarcoma and chondrosarcoma was made [Figure 2]. | Figure 2: Case 2 - Phyllodes tumor with malignant osteoid (a) and cartilage (b) (H and E, ×400)
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Case 3
A 27-year-old female presented with a lump in the breast of 2 months duration and was lactating for 11 months. Sections from the excised lump were reviewed, which showed a tumor composed of malignant ductal cells surrounded by a desmoplastic stroma (Grade II) consistent with infiltrating ductal carcinoma. Hormonal receptor status was not performed [Figure 3].
Case 4
A 25-year-old female lactating for 1 year presented with a history of breast lump of 1 month duration. Lumpectomy specimen showed a firm grey-white tumor measuring 5.5 cm x 5 cm x 3 cm. Sections showed a tumor composed of malignant ductal cells with pleomorphic vesicular nuclei and occasional prominent nucleoli (Grade II). Adjacent acini showed lactational changes. The tumor was ER and PR status negative and Her2 neu - 2+ [Figure 4].  | Figure 4: Case 4 - Lactating breast with infiltrating ductal carcinoma (H and E, ×400)
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 Discussion | |  |
Breast carcinoma is the second most common malignancy in pregnancy following carcinoma cervix. The average age documented in PABC in the Western literature is between 28 and 32 years and an increase in frequency is expected due to an increase in the birth rates for women in their 30s. [1],[3] The most commonly reported subtype is infiltrating ductal carcinoma. [4]
Malignant phyllodes, in contrast, is a rare tumor during gestation and is associated with accelerated growth during pregnancy. [5] Heterologous differentiation is known and few cases have been reported in the literature associated with osteosarcoma. [6] However, no cases of synchronous osteosarcoma and chondrosarcoma have been documented in lactating breasts. We would like to highlight this case.
This case series is an attempt to study the various tumors encountered in pregnancy and lactation and to emphasize the occurrence of malignant phyllodes in young females. Studies on demography, frequency, survival and variants of breast carcinoma in pregnancy and lactation, especially in an Indian setting, are poorly documented and hence there is a need for further discussion and data.
| References | | |
| 1. | Robinson DS, Sundaram M, Lakin GE. Carcinoma of the breast in pregnancy and lactation. In: Bland KI, Copeland EM, editors. The Breast: A Comprehensive Textbook for the Management of Benign and Malignant Diseases. 2 nd ed. Philadelphia: WB Saunders; 1998. p. 1433-45. 
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| 2. | Petrek JA. Breast cancer during pregnancy. Cancer 1994;74:518-27.
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| 3. | Ahrendt GM. Pregnancy and breast cancer. In: Donegan WL, Spratt JS, editors. Cancer of the breast. 5 th ed. Philadelphia: Saunders; 2002. p. 909-15.
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| 4. | Rosemond GP, Maier WP. Pregnancy and breast cancer. In: Gallenger HS, Leis HP, Synderman RK, Urban JA, editors. The breast. St. Louis: GV Mosby; 1978. p. 532-8.
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| 5. | Nejc D, Pasz-Walczak G, Piekarski J, Pluta P, Bilkski A, Sek P, et al. Astonishingly rapid growth of malignant cystosarcoma phyllodes tumor in a pregnant women: A case report. Int J Gynecol Cancer 2008;18:856-9.
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| 6. | Pandit AA, Vora IM, Shenoy SG, Gurjar AM. Bilateral cystosarcoma phyllodes with osteogenic sarcomatous stroma (a case report with review of literature). J Postgrad Med 1985;31:215-6.
[PUBMED]  |
Correspondence Address:
Mary Mathew
Department of Pathology, Kasturba Medical College, Manipal University, Manipal - 576 104, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.72037
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1] |
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