Diffusely Invasive Breast Cancer

• Diffusely invasive carcinoma:
  • Has a mammographic appearance of diffuse architectural distortion:
    • Usually involving a large area, often larger than a lobe:
      • With no central tumor mass and no calcifications:
      • • It sometimes has the appearance of a “spider’s web” as shown in the Image

• The diffusely infiltrating cancer:
  • Forms concave contours with the surrounding fat in a manner similar to normal fibroglandular tissue (Images)

• The imaging findings of diffusely infiltrating breast cancer are strikingly different:
  • From the imaging findings of breast cancers originating either from the terminal ductal lobular units (TDLUs) or the lactiferous ducts:
  • • Suggesting that it may have a different site of origin

• It has been recently proposed that diffusely infiltrating breast cancers:
  • May originate from mesenchymal stem cells (progenitors):
    • Through a complex process of both:
      • Epithelial-mesenchymal transformation and more frequently, mesenchymal-epithelial transformation

• The clinical presentation:
  • Is typically a recently detected, extensive, firm lesion:
    • Often appearing as an interval cancer following a previous mammogram which was interpreted as normal

• On clinical breast examination:
  • The cancer does not have a distinct tumor mass or focal skin retraction seen in other cancers:
    • But rather an indistinct “thickening” and eventually a shrinkage of the breast.

• In order to make the diagnosis before the development of a palpable mass and a decrease in size of the breast:
  • The radiologist and breast surgeon must have a high level of suspicion and a thorough knowledge of the underlying pathophysiology

• The subgross (3D) histopathology images show how growth of the mesenchymal tissue:
  • Distorts the normal, harmonious connective tissue framework:
    • By causing nonuniform thickening of the fine sheets of connective tissue (Images):

• The predominance of mesenchyme in the diffusely infiltrating breast malignancy:
  • Allows it to be imaged with greater sensitivity by ultrasound than by mammography:

• • • The thin sheets or veils of tissue reflect the ultrasound waves:
      • But are relatively easily penetrated by x-rays

• • The structural / architectural distortion:
  • • While difficult to detect mammographically:
      • Is readily detectable on 2-mm thick coronal sections of automated breast ultrasound (Image)

• The 2-mm thick multi-slice series demonstrate the extensive architectural distortion, corresponding to the 3D histology:

• The hypoechoic changes can also usually be seen on hand held ultrasound, Image:

• The growth pattern and cell type of diffusely invasive breast cancer:
  • Is very similar to that of diffuse gastric carcinoma (linitis plastica), and both of these diseases can be associated with:
    • A deleterious mutation in the CDH1 gene:
      • Which is located on chromosome 16q22 and codes for e-cadherin protein (Image):

• CDH1 was initially known as a susceptibility gene for diffuse gastric cancer (linitis plastica)

• The histopathologic characteristics of diffuse gastric cancer:
  • Show similarities with e-cadherin negative:
    • Diffusely infiltrating breast cancer (infiltrating “lobular” carcinoma)
  • The neoplastic cells permeate the mucosa and wall as scattered individual signet-ring cells or small clusters of cells in an infiltrative growth pattern

• Since there are no TDLUs in the stomach:
  • If the similar cells in both conditions associated with CDH1 have a common origin, it could not be a TDLU:
  • • Raising the possibility that they could result from mesenchymal cell transformation in both organs

👉Rodrigo Arrangoiz MS, MD, FACS, FSSO cirujano oncology y cirujano de mamá de en Mount Sinai Medical Center:

• Es experto en el manejo del cáncer de mama

 👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer