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Review article
Mucinous carcinoma of the breast: distinctive histopathologic and genetic characteristics
Minjung Jung
Kosin Med J. 2022;37(3):176-186.   Published online August 25, 2022
DOI: https://doi.org/10.7180/kmj.22.022
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Mucinous carcinoma is a rare histologic type of breast cancer that, when classified with favorable histology, can be treated with different therapeutic options. This study reviews the histologic findings of mucinous carcinoma that support or exclude favorable histology and emphasizes the necessity of an appropriate gross examination with radiologic findings for an accurate diagnosis. In addition, unusual findings such as micropapillary arrangements and lobular differentiation in mucinous carcinoma and their implications for prognosis and treatment are reviewed. Mucinous carcinoma involves upregulation of MUC2, a mucus-associated gene common in mucinous carcinoma of the breast as well as various other organs. In mucinous carcinoma, the fraction of genome altered and tumor mutation burden are lower than those of invasive carcinoma of no special type, the most common histology of breast cancer. In addition, the genetic alterations found in mucinous carcinoma are diverse, unlike the pathognomonic genetic alterations observed in other histologic types of breast cancer. These genetic features support the importance of conventional microscopic evaluations for the pathologic differential diagnosis of mucinous carcinoma of the breast in routine practice. A variety of breast lesions, including mucinous cystadenocarcinoma and mucocele-like lesions, as well as mucinous carcinoma from other organs, can mimic mucinous carcinoma of the breast. In order to obtain an accurate pathologic diagnosis, careful evaluation of the overall histopathologic characteristics and ancillary testing are required to provide information on appropriate treatment and prognosis.
Original articles
The Effectiveness of Dexmedetomidine in Vacuum-Assisted Breast Biopsy Under Monitored Anesthesia Care
Kyung Woo Kim, Jun Ha Park, Seunghwan Kim, Eun Jin Ahn, Hyo Jin Kim, Hey Ran Choi, Yeo Goo Chang, Si Ra Bang
Kosin Med J. 2019;34(1):24-29.   Published online June 30, 2019
DOI: https://doi.org/10.7180/kmj.2019.34.1.24
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Objectives

Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB.

Methods

This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs.

Results

The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability.

Conclusions

VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.

Diagnostic value of magnetic resonance imaging using superparamagnetic iron oxide for axillary node metastasis in patients with breast cancer: a meta-analysis
Ru Da Lee, Jung Gu Park, Dong Won Ryu, Yoon Seok Kim
Kosin Med J. 2018;33(3):297-306.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.297
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Objectives

Identification of axillary metastases in breast cancer is important for staging disease and planning treatment, but current techniques are associated with a number of adverse events. This report evaluates the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) techniques for identification of axillary metastases in breast cancer patients.

Methods

We performed a meta-analysis of previous studies that compared SPIO enhanced MRI with histological diagnosis after surgery or biopsy. We searched PubMed, Ovid, Springer Link, and Cochrane library to identify studies reporting data for SPIO enhanced MRI for detection of axillary lymph node metastases in breast cancer until December 2013. The following keywords were used: “magnetic resonance imaging AND axilla” and “superparamagnetic iron oxide AND axilla”. Eligible studies were those that compared SPIO enhanced MRI with histological diagnosis. Sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analyses were done. Study quality and heterogeneity were also assessed.

Results

There were 7 publications that met the criteria for inclusion in our meta-analysis. SROC curve analysis for per patient data showed an overall sensitivity of 0.83 (95% Confidence interval (CI): 0.75–0.89) and overall specificity of 0.97 (95% CI: 0.94–0.98). Overall weighted area under the curve was 0.9563.

Conclusions

SPIO enhanced MRI showed a trend toward high diagnostic accuracy in detection of lymph node metastases for breast cancer. So, when the breast cancer patients has axillary metastases histologically, SPIO enhanced MRI may be effective diagnostic imaging modality for axillary metastases.

Analysis of factors related systemic recurrence after breast conserving surgery in stage I breast cancer
Yoon-Seok Kim, Dong-Won Ryu, Chung-Han Lee
Kosin Med J. 2018;33(3):289-296.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.289
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Objectives

In these days, patients with stage I breast cancer have increased by regular health examination and diagnostic tool development. The aim of this retrospective study is to identify systemic recurrence related factors after breast conserving surgery (BCS) for stage I breast cancer.

Methods

In this study, we analyzed the correlation between systemic recurrence and pathologic factors. We reviewed 223 patients who underwent BCS for stage I breast cancer. Postoperative pathologic factors, recurrent rates and sites were studied. In addition, preoperative patients'data were also collected. Statistical analysis was done by using PASW 16.0 (SPSS Inc., Chicago, IL, USA).

Results

Systemic recurrence was found in 16 patients (7.17%) within 5 years after primary surgery. 5 patients had lymphatic invasion and 6 patients had vascular invasion. Lymphatic and vascular invasion had statistical correlation with systemic recurrence (P = 0.004, P = 0.001).

Conclusions

In this retrospective study, we can conclude that vascular invasion and lymphatic invasion are related systemic recurrence after BCS for stage I patients. Further studies with large cohort will be required to fully understand the risk factors of systemic recurrence for stage I breast cancer patients.

Utility of Regular Radiological Follow-up on Early Detection of Contralateral Malignancy and Long-term Outcomes in Metachronous Bilateral Breast Cancer Patients
Hyo Sun Kim, Sun Hee Kang
Kosin Med J. 2017;32(1):72-83.   Published online June 30, 2017
DOI: https://doi.org/10.7180/kmj.2017.32.1.72
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Objectives

We investigated the utility of regular radiological follow-up on the early detection of contralateral breast cancer(CBC) and prognosis in patients with metachronous bilateral breast cancer.

Methods

Between 1983 and 2010, 49(2.1%) metachronous bilateral breast cancer patients were identified among a total of 2,343 cases of invasive or in situ breast carcinomas. We reviewed the patients' medical records including age, stage, duration between the first and second breast cancer diagnosis, operation method, recurrence, and breast cancer-specific survival.

Results

The mean ages at the first and second breast cancer diagnosis were 43.8 and 49.2 years, respectively. The mean duration between the first and second breast cancer diagnosis was 68.9 months (range, 7–266 months). Regular radiological follow-up with annual mammography(MMG) with or without ultrasonography was conducted in 28 patients (63.6%, Group 1), and no regular follow-up was performed in 12 patients (27.3%, Group 2). The median follow-up duration was 150 months. In a comparative analysis, Group 1 patients exhibited more stage 0 and stage 1 malignancies (82.1% vs. 25%, P =0.006) as second cancer and the same or an improved stage (71.4% vs. 33.3%, P =0.042) of second cancer compared to Group 2 patients. Breast cancer-specific survival rates between the two groups after the first cancer occurrence were higher in Group 1 patients compared to Group 2 patients, although this did not reach statistical significance.

Conclusion

Screening for CBC with regular radiological follow-up could result in early detection of CBC, less invasive surgical procedures, and enhanced breast cancer-specific survival outcomes.

Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients
Yoon Seok Kim, Dong Won Ryu, Chung Han Lee
Kosin Med J. 2016;31(1):19-29.   Published online February 4, 2016
DOI: https://doi.org/10.7180/kmj.2016.31.1.19
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Abstract Objectives

Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM).

Methods

In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected.

Results

Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P< 0.01). However, there was no significant correlation between overall survival period and operative methods (P= 0.67). In addition, recurrence pattern (P= 0.21), recurrent rate (P= 0.36) and site (P= 0.45, P= 0.09) were not associated with operative method.

Conclusions

In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.

Mucinous precursor lesions of mucinous carcinoma in breast: Incidence and histopathologic features
Min Jung Jung, Young Ok Kim
Kosin Med J. 2015;30(2):131-139.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.131
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Abstract Objectives

Columnar cell lesion (CCL), atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) may be premalignant lesion of mammary invasive carcinoma. A few recent investigators reported that the precursor lesions exhibited mucin production and they might be potential precursor lesion for mucinous carcinoma (mCA). This study aims to investigate the incidence and histopathologic characteristics of mucinous precursor lesions, including mucinous DCIS (mDCIS) and mucinous CCL (mCCL).

Methods

We retrospectively analyzed invasive carcinomas with mucin. Cases were grouped into three subgroups: pure mCA, mixed mCA, and invasive carcinoma of no special type with mucin production (IC of NST-m). Precursor lesions were evaluated with PAS and alcian blue staining.

Results

Total 27 cases of invasive carcinoma with mucin were analysed and classified as 18 pure mCA, 7 mixed mCA, and 2 IC of NST-m. mDCISs were found in 12 pure mCA, 4 mixed mCA and 2 IC of NST-m. mCCLs were found in 7 pure mCA and 2 mixed mCA. Majority of mucin was identified in both cytoplasm and ductal lumen, while some tumors exhibited only cytoplasmic mucin. We also observed three patterns of mDCIS classifiable by location of mucin and architecture of tumor cells.

Conclusions

Cytoplasmic mucin suggested that mucinous feature of precursor lesions in the vicinity of mCA might not be a passive morphologic finding but be involved in development of mCA.

Review article
Effect of Docosahexaenoic Acid (DHA) on Breast Cancer Cells
Sun-yong Hwang, Tae-Hee Kim, Hae-Hyeog Lee, Heung Yeol Kim, Juhyun Seo
Kosin Med J. 2015;30(2):103-107.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.2.103
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Abstract

Today, many materials as drug are developed having various prominent function in order to treatment of disease or cancer. Among these materials, especially docosahexaenoic acid (DHA), main constituents of omega-3 fatty acid, has a lot of beneficial and natural effects, so it has been known as anticancer material especially breast cancer. Breast cancer is disease taking high occurrence level among feminine diseases. DHA has anticancer effects on breast cancer cell, representatively inducing apoptosis, inhibiting proliferation or metastasis. Main effect of DHA on breast cancer cell is apoptosis inducing, which has mechanism that treated DHA causes lipid peroxidation increasing reactive oxygen species (ROS) level and it activates caspase 8 and caspase 9 so activated caspase occurs apoptosis. Cell lines of breast cancer are MDA-MB-231, MCF-7, SK-BR-3, T47D and ZR75. Especially this article uses the MCF-7 cell line at experiment of anti-proliferation by DHA, the MDA-MB-231 cell line at experiment of anti-metastasis by DHA, because that cell line has specialized metastasis activity. Therefore, this paper discusses the effects of natural material DHA as drug of breast cancer.

Citations

Citations to this article as recorded by  
  • The Function and Mechanism of Lipid Molecules and Their Roles in The Diagnosis and Prognosis of Breast Cancer
    Rui Guo, Yu Chen, Heather Borgard, Mayumi Jijiwa, Masaki Nasu, Min He, Youping Deng
    Molecules.2020; 25(20): 4864.     CrossRef
  • Plasma metabolites as possible biomarkers for diagnosis of breast cancer
    Jiwon Park, Yumi Shin, Tae Hyun Kim, Dong-Hyun Kim, Anbok Lee, Mohana Krishna Reddy Mudiam
    PLOS ONE.2019; 14(12): e0225129.     CrossRef
Case report
Peritoneal and gastric metastasis from invasive lobular breast carcinoma: a case report
Yoon Seok Kim, Eun Ae Jae, Dong Won Ryu, Chung Han Lee
Kosin Med J. 2015;30(1):87-92.   Published online January 20, 2015
DOI: https://doi.org/10.7180/kmj.2015.30.1.87
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Abstract

Peritoneal and gastrointestinal metastasis from breast cancer is very rare. We report here a rare case of metastatic peritoneal and gastric cancer from breast lobular carcinoma after modified radical mastectomy. A 65-year old woman presented with anorexia, nausea, vomiting and dyspepsia for several weeks at 44 months after surgery. Radiologic study showed peritoneal metastasis, and surgical histopathology reported peritoneal and omental metastatic carcinoma. Esophagogastroduodenoscopic (EGD) biopsy also confirmed metastatic carcinoma originated from breast primary.

Citations

Citations to this article as recorded by  
  • Effect of Docosahexaenoic Acid (DHA) on Breast Cancer Cells
    Sun-yong Hwang, Tae-Hee Kim, Hae-Hyeog Lee, Heung Yeol Kim, Juhyun Seo
    Kosin Medical Journal.2015; 30(2): 103.     CrossRef
Original article
The Study in Vitamin D Concentration in the Blood for Infants with High Level of Alkaline Phosphatase
Ji Sung Kim, Jae Yong Choi, Kyun Woo Lee, Ick Jin Song, Cheol Am Kim, Byeong Hee Son, Jung Hyun Lee
Kosin Med J. 2012;27(1):17-24.   Published online June 11, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.1.17
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM
Objectives

Nowadays most infants on exclusively breast feeding have vitamin D deficiency due to the increase of breast feeding. However, domestic research lacks appropriate materials. Therefore, we researched practical clinical aspects of vitamin D deficiency related to breast milk feeding for infants who have a high amount of alkaline phosphatase (> 500 IU/L).

Methods

The subjects of the study were 31 infants with high alkaline phosphatase level. We tested with 25-hydroxycholecalciferol (25-OHD3), parathyroid hormone, calcium, ionized calcium, phosphorus in their blood and with a wrist x-ray. Then, we divided them into two groups of breast feeding and formula feeding and compared the results.

Results

Eighteen infants (58%) out of 31 infants that have high alkaline phosphatase were vitamin D insufficiency or deficiency, and 16 (100%) breast feeding infants of them showed vitamin D deficiency or insufficiency. However, only 2 (13%) of 15 formula feeding infants were at insufficiency. There was a correlation between alkaline phosphatase and 25-OHD3 concentration in multiple regression analysis, but no correlation in other variables was found in group of breast milk feeding infants. There was neither correlation between vitamin D concentration and alkaline phosphatase nor other correlated variables in the group of formula milk feeding infants.

Conclusions

In this study, there was a high probability of vitamin D deficiency in the breast feeding infants with a high alkaline phosphatase level. Therefore, it is considered to be worth utilizing alkaline phosphatase as a screening test for vitamin D deficiency or rickets for breast feeding infants.

Citations

Citations to this article as recorded by  
  • The Role of Vitamin D in Menopausal Medicine
    Mijin Kim, Tae-Hee Kim, Hae-Hyeog Lee, Heung Yeol Kim, Min-Jung Oh
    Kosin Medical Journal.2016; 31(2): 97.     CrossRef
  • The Role of Vitamin D in Menopausal Medicine
    Mijin Kim, Tae-Hee Kim, Hae-Hyeog Lee, Heung Yeol Kim, Min-Jung Oh
    Kosin Medical Journal.2016; 31(2): 97.     CrossRef
  • Recent Updates on Vitamin D and Pediatric Gastrointestinal Diseases
    Ji-Hyun Seo, Ju Young Chang, Ji Sook Park, Chan-Hoo Park, Hee-Shang Youn
    Pediatric Gastroenterology, Hepatology & Nutrition.2012; 15(3): 138.     CrossRef
Review article
Circulating Tumor Cells and Extracellular Nucleic Acids in Breast Cancer
Dong Won Ryu, Chung Han Lee
Kosin Med J. 2012;27(1):1-9.   Published online June 11, 2012
DOI: https://doi.org/10.7180/kmj.2012.27.1.1
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Abstract PDFPubReader   ePub   CrossRef-TDMCrossref - TDM

Circulating tumor cells (CTCs) are defined as tumor cells circulating in the peripheral blood of patients, shed from either the primary tumor or from its metastases. The detection of circulating tumor cells (CTCs) in the peripheral blood of breast cancer patients may account for the different steps in the biologic progression of the disease. The detection of microscopic disease in patients with breast cancer is imperative to prognosis and can predict the efficacy of targeted treatments. In general, there are two main methods for their detection. These are based on cytometric and nucleic acid manipulation. Both methods generally require an enrichment step to increase sensitivity of the assay. This step is based on either detection of specific surface markers using immuno-selection and/or on morphological features, such as cell size or density. We review the methods of detecting CTCs, their prognostic implications, and opportunities to exploit the properties of CTCs to develop personalized therapy.

Citations

Citations to this article as recorded by  
  • Effect of Docosahexaenoic Acid (DHA) on Breast Cancer Cells
    Sun-yong Hwang, Tae-Hee Kim, Hae-Hyeog Lee, Heung Yeol Kim, Juhyun Seo
    Kosin Medical Journal.2015; 30(2): 103.     CrossRef
Original articles
Clinical Usefulness of Cytokeratin 5/6 as an Immunohistochemical Marker to Predict Prognosis in Triple-negative Breast Cancer
Woo Sik Choi, Dong Won Ryu, Chung Han Lee
Kosin Med J. 2010;25(2):20-25.   Published online December 31, 2010
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Influencing Factors of Periodic Medical Check-up of Breast Cancer Among Nurses
Eun Soon Sim, Byeng Chul Yu
Kosin Med J. 2010;25(2):57-64.   Published online December 31, 2010
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Ki-67 index, Luminal B Type, and Prognosis of Patients with Breast Cancer
Dong Won Ryu, Woo Sik Choi, Chung Han Lee
Kosin Med J. 2010;25(1):59-65.   Published online June 30, 2010
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The Usefulness of Sonographic Screening for Thyroid Cancer in Breast Ultrasonography
Kyung Soon Jeong
Kosin Med J. 2009;24(2):27-31.   Published online December 31, 2009
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KMJ : Kosin Medical Journal