Le phéochromocytome est une tumeur rare, potentiellement létale qui peut être révélée par la grossesse mimant un tableau de prééclampsie.Nous rapportons le cas d’une patiente âgée de 30 ans, sans antécédents particuliers, primigeste, atteinte d’un phéochromocytome dont le tableau clinique a mimé une prééclampsie sévère à un terme de 32 semaines d’aménorrhée, nécessitant une extraction fœtale. Le diagnostic a été confirmé après l’accouchement devant la persistance d’une labilité tensionnelle et la présence d’une lésion surrénalienne droite de 19 mm à l’imagerie. Une surrénalectomie par voie cœlioscopique a été faite. Les analyses génétiques n’ont révélé aucune anomalie.L’association phéochromocytome et grossesse est rare pouvant mettre en jeu le pronostic vital maternel et fœtal. Elle pose un problème diagnostique. Il convient d’y penser systématiquement face à une hypertension artérielle gravidique atypique, accompagnée de signes cliniques évocateurs, ou résistante au traitement.Pheochromocytoma is a rare, potentially lethal tumour that can be revealed by pregnancy and mistaken as a pre-eclampsia.We report the case of a 30-year-old patient, with no particular history, primigravida, suffering from a pheochromocytoma whose taken like a severe pre-eclampsia at a term of 32 weeks requiring foetal extraction. The diagnosis was confirmed during postpartum based on persistent blood pressure lability and the presence of a 19 mm right adrenal lesion on imaging. Genetic analyses showed no abnormality.The association pheochromocytoma and pregnancy is rare and can jeopardize maternal and foetal vital prognosis. It poses a diagnostic problem. We must systematically think about it in the face of atypical gravidic hypertension, accompanied by suggestive clinical signs, or resistant to treatment.

Abstract The lungs are a frequent target of metastatic breast cancer cells, but the underlying molecular mechanisms are unclear. All existing data were obtained either using statistical association between gene expression measurements found in primary tumors and clinical outcome, or using experimentally derived signatures from mouse tumor models. Here, we describe a distinct approach that consists of using tissue surgically resected from lung metastatic lesions and comparing their gene expression profiles with those from nonpulmonary sites, all coming from breast cancer patients. We show that the gene expression profiles of organ-specific metastatic lesions can be used to predict lung metastasis in breast cancer. We identified a set of 21 lung metastasis–associated genes. Using a cohort of 72 lymph node–negative breast cancer patients, we developed a 6-gene prognostic classifier that discriminated breast primary cancers with a significantly higher risk of lung metastasis. We then validated the predictive ability of the 6-gene signature in 3 independent cohorts of breast cancers consisting of a total of 721 patients. Finally, we show that the signature improves risk stratification independently of known standard clinical variables and a previously established lung metastasis signature based on an experimental breast cancer metastasis model. [Cancer Res 2008;68(15):6092–9]

Supplementary Table 1 from A Six-Gene Signature Predicting Breast Cancer Lung Metastasis

Women with pathogenic germline BRCA1 or BRCA2 variants have a higher risk of breast cancer than in the general population. International guidelines recommend specific clinical and radiological breast follow-up. This specific breast screening program has already been shown to be of clinical benefit, but no information is available concerning the use of prognostic factors or specific survival to guide follow-up decisions. We evaluated “high-risk” screening in a retrospective single-center study of 520 women carrying pathogenic germline variants of the BRCA1 or BRCA2 gene treated for breast cancer between January 2000 and December 2016. We compared two groups of women: the incidental breast cancer group (IBCG) were followed before breast cancer diagnosis ( N = 103), whereas the prevalent breast cancer group (PBCG) ( N = 417) had no specific follow-up for high risk before breast cancer diagnosis. Breast cancers were diagnosed at an earlier stage in the IBCG than in the PBCG: T0 in 64% versus 19% of tumors, ( p < 0.00001), and N0 in 90% vs. 75% ( p < 0.00001), respectively. Treatment differed significantly between the 2 groups: less neoadjuvant chemotherapy (7.1% vs. 28.5%, p < 0.00001), adjuvant chemotherapy (47.7% vs. 61.9%, p = 0.004) and more mastectomies (60% vs. 42% p < 0.0001) in the IBCG vs PBCG groups respectively. Overall and breast cancer-specific mortality were similar between the two groups. However, the patients in the IBCG had a significantly longer metastasis-free survival than those in the PBCG, at three years (96.9% [95% CI 93.5–100] vs. 92.30% [95% CI 89.8–94.9]; p = 0.02), suggesting a possible long-term survival advantage.

Background Neoadjuvant endocrine therapy (NET) has shown efficacy in terms of clinical response and surgical outcome in postmenopausal patients with estrogen receptor-positive / HER2-negative breast cancer (ER+/HER2- BC) but monitoring of tumor response is challenging. The aim of the present study was to investigate the value of an early metabolic response compared to morphological and pathological responses in this population. Methods This was an ancillary study of CARMINA 02, a phase II clinical trial evaluating side-by-side the efficacy of 4 to 6 months of anastrozole or fulvestrant. Positron Emission Tomography/Computed Tomography using 2-deoxy-2-[ 18 F]fluoro-D-glucose (FDG-PET/CT) scans were performed at baseline (M0), early after 1 month of treatment (M1) and pre-operatively in 11 patients (74.2 yo ± 3.6). Patients were classified as early “metabolic responders” (mR) when the decrease of SUVmax was higher than 40%, and “metabolic non-responders” (mNR) otherwise. Early metabolic response was compared to morphological response (palpation, US and MRI), variation of Ki-67 index, pathological response according to the Sataloff classification and also to Preoperative Endocrine Prognostic Index (PEPI) score. It was also correlated with overall survival (OS) and recurrence-free survival (RFS). Results Tumor size measured on US and on MRI was smaller in mR than mNR, with the highest statistically significant difference at M1 ( p = 0.01 and 7.1 × 10 − 5 , respectively). No statistically significant difference in the variation of tumor size between M0 and M1 assessed on US or MRI was observed between mR and mNR. mR had a better clinical response: no progressive disease in mR vs 2 in mNR and 2 partial response in mR vs 1 partial response in mNR. One patient with a pre-operative complete metabolic response had the best pathological response. Pathological response did not show any statistically significant difference between mR and mNR. mR had better OS and RFS (Kaplan-Meier p = 0.08 and 0.06, respectively). All cancer-related events occurred in mNR: 3 patients died, 2 of them from progressive disease. Conclusions FDG-PET/CT imaging could become a “surrogate marker” to monitor tumor response, especially as NET is a valuable treatment option in postmenopausal women with ER+/HER2- BC.

Background: CT lung extent has emerged as a potential risk factor of COVID-19 pneumonia severity with mainly semiquantitative assessment, and outcome was not assessed in the specific oncology setting. The main goal was to evaluate the prognostic role of quantitative assessment of the extent of lung damage for early mortality of patients with COVID-19 pneumonia in cancer patients.Methods: We prospectively included consecutive cancer patients with recent onset of COVID-19 pneumonia assessed by chest CT between March 15, 2020, and April 20, 2020, and followed until May 1, 2020. Demographic, clinical, laboratory test data and imaging findings were recorded. Quantitative chest CT assessment of COVID-19 pneumonia was based on the density distribution of lung lesions using a freely available software recently released (Myrian XP-Lung). The association between extent of lung damage and overall survival was studied by univariate and multivariate Cox analysis. The Uno C-index was used to assess the discriminatory value of the quantitative CT extent of lung damage.Results: Seventy cancer patients with chest CT evidence of COVID-19 were included. After a median follow-up of 25 days, 17 patients (24%) had died. The median quantitative chest CT extent of COVID-19 was 20% (IQR = 14–35, range = 3–59) for non-survivors vs. 10% (IQR = 6–15, range = 2–55) for survivors (p = 0.002). The extent of COVID-19 pneumonia was correlated with inpatient management (p = 0.003) and oxygen therapy requirements (p < 0.001). Independent factors associated with death were performance status (PS) ≥2 (HR = 3.9, 95% CI = [1.1–13.8] p = 0.04) and extent of COVID-19 pneumonia ≥30% (HR = 12.0, 95% CI = [2.2–64.4] p = 0.004). No differences were found regarding the histology of cancer, cancer stage, metastases sites, or type of oncologic treatment between the survivor and non-survivor groups. The cross-validated Uno C-index of the model including PS and extent of COVID-19 pneumonia was 0.83, 95% CI = [0.73–0.93].Conclusions: The quantitative chest CT extent of COVID-19 pneumonia was a strong independent prognostic factor of early inpatient mortality in a population of cancer patients.

PURPOSE:We evaluated the addition of breast magnetic resonance imaging (MRI) to standard radiologic evaluation on the re-intervention rate in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery.PATIENTS AND METHODS:Women with biopsy-proven DCIS corresponding to a unifocal microcalcification cluster or a mass less than 30 mm were randomly assigned to undergo MRI or standard evaluation. The primary end point was the re-intervention rate for positive or close margins (< 2 mm) in the 6 months after randomization ( ClinicalTrials.gov identifier: NCT01112254).RESULTS:A total of 360 patients from 10 hospitals in France were included in the study. Of the 352 analyzable patients, 178 were randomly assigned to the MRI arm, and 174 were assigned to the control arm. In the intent-to-treat analysis, 82 of 345 patients with the assessable end point were reoperated for positive or close margins within 6 months, resulting in a re-intervention rate of 20% (35 of 173) in the MRI arm and 27% (47 of 172) in the control arm. The absolute difference of 7% (95% CI, -2% to 16%) corresponded to a relative reduction of 26% (stratified odds ratio, 0.68; 95% CI, 0.41 to 1.1; P = .13). When considering only the per-protocol population with an assessable end point, the difference was 9% (stratified odds ratio, 0.59; 95% CI, 0.35 to 1.0; P = .05). Total mastectomy rates were 18% (31 of 176) in the MRI arm and 17% (30 of 173) in the control arm (stratified P = .93). For 100 lesions seen on MRI, nonmass-like enhancement was more predominant (82%) than mass enhancement (20%). Nevertheless, no specific morphologic and kinetic parameters for DCIS were identified.CONCLUSION:The study did not show sufficient surgical improvement with the use of preoperative MRI to be clinically relevant in DCIS staging. However, this could be reconsidered with the improvement of new MRI sequences and new modalities in magnetic resonance techniques.

Hyperechogenicity is a sign classically reported to be in favour of a benign lesion and can be observed in many types of benign breast lesions such as hamartoma, lipoma, angiolipoma, haemangioma, haematoma, fat necrosis, fibrosis and galactocele, among others. However, some rare malignant breast lesions can also present a hyperechoic appearance. Most of these hyperechoic malignant lesions present other characteristics that are more typically suggestive of malignancy such as posterior shadowing, a more vertical axis or irregular margins that help to guide the diagnosis. Post magnetic resonance imaging, second-look ultrasound may visualise hyperechoic malignant lesions that would not have been identified at first sight and radiologists must know how to recognise these lesions.TEACHING POINTS:• Some rare malignant breast lesions can present a hyperechoic appearance. • Malignant lesions present other characteristics that are suggestive of malignancy. • An echogenic mass with fat density on mammography does not require biopsy.

Primary neuroendocrine carcinoma of the breast is a poorly defined type of carcinoma based on clinical and radiologic presentation, histopathology characteristics, treatment and survival. We analysed all these elements in our study of 45 patients with a primary neuroendocrine breast carcinoma treated between August 2004 and February 2015 at Rene-Huguenin institut Curie Cancer Centre. This type of carcinoma was more often seen in women between 60 and 70 years old, who consulted for palpable mass. Upon radiological examination, a mass was detected, usually a single one, which was round or oval with partially circumscribed borders in a third of the cases. With regards to histopathology, the tumours were low or intermediate grade, with positive oestrogen and progesterone receptors. They could have been easily misdiagnosed because neuroendocrine markers research is not done routinely. Moreover, it is challenging to differentiate from breast metastasis of neuroendocrine tumour. Neuroendocrine breast carcinoma treatment is similar to that for invasive breast carcinoma. There is a good survival rate, despite contradictory evidence in studies. (C) 2017 Elsevier Masson SAS. All rights reserved.

Objective > Lobular intraepithelial neoplasia (LIN) diagnosed on image-guided biopsy may be associated with an undiagnosed cancer. This is called under-diagnosis. The consequence is that management of these lesions is often surgical. But many surgeries finally are unnecessary. The aim of our study was to define criteria to avoid unnecessary surgery.Materials and methods > This is a single-center, retrospective after a database collected prospectively study. Fourteen thousand biopsies were analyzed, including 456 diagnosed NLI. Under diagnosis rates were analyzed according to many criteria. The average duration of following was 45 months.Results > For atypical lobular hyperplasia (ALH), we obtained 7.6% under-diagnosis and combining several criteria, we got a low risk of cancer (2%). For LCIS, this rate was 23% and any low-risk group could be identified.Conclusion > ALH with calcifications <= 20 mm, without any atypical lesion associated, histologically focal and whose removal is representative may be safely observed. For other LIN, surgery remains indicated.

BACKGROUNDTreatment strategies for locally advanced breast cancer in elderly patients too frail to receive neoadjuvant chemotherapy and the introduction of new classes of drugs in the early 2000s have led to the consideration of endocrine therapy as a neoadjuvant treatment for younger hormone receptor (HR)–positive, postmenopausal patients not eligible for primary breast‐conserving surgery (BCS).METHODSThis was a multicenter, phase 2, randomized trial designed to evaluate as its primary objective the clinical response rate after up to 6 months of neoadjuvant endocrine therapy (NET) alone in HR‐positive/human epidermal growth factor receptor 2 (HER2)–negative patients with 1 mg of anastrozole (arm A) or 500 mg of fulvestrant (arm B). Secondary objectives included the BCS rate, tumor response assessment (breast ultrasound and magnetic resonance imaging), pathological response (Sataloff classification), safety profile, relapse‐free survival (RFS), and predictive markers of responses and outcomes.RESULTSFrom October 2007 to April 2011, 116 women (mean age, 71.6 years) with operable infiltrating breast adenocarcinoma (T2‐T4, N0‐N3, M0) were randomized to receive anastrozole or fulvestrant. The clinical response rates at 6 months were 52.6% (95% confidence interval [CI], 41%‐64%) in arm A and 36.8% (95% CI, 25%‐49%) in arm B. BCS was performed for 57.6% of arm A patients and 50% of arm B patients. The RFS rates at 3 years were 94.9% in arm A and 91.2% in arm B. The Preoperative Endocrine Prognostic Index status was significantly predictive of RFS. Both treatments were well tolerated.CONCLUSIONSBoth drugs are effective and well tolerated as NET in postmenopausal women with HR‐positive/HER2‐negative breast cancer. NET could be considered a treatment option in this subpopulation. Cancer 2016;122:3032‐3040. © 2016 American Cancer Society.

Purpose To assess the rate of underestimation of atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) at magnetic resonance (MR) imaging-guided vacuum-assisted breast biopsy and to explore the imaging, demographic, and histologic characteristics associated with lesion upgrade after surgery. Materials and Methods This retrospective study had institutional review board approval, and the need to obtain informed patient consent was waived. A total of 1509 MR imaging-guided vacuum-assisted biopsy procedures were performed in nine centers. A diagnosis of ADH was obtained after biopsy in 72 cases, and a diagnosis of DCIS was obtained in 118 cases. Pearson χ2 and Fisher tests were used to assess the association between demographic, MR imaging, and biopsy features and lesion upgrade. Univariate statistical analyses were performed, and each significant parameter was entered into a multivariate logistic regression analysis. Results Surgical excision was performed in 66 of the 72 ADH cases and in 117 of 118 DCIS cases. The ADH and DCIS underestimation rates were 25.8% (17 of 66) and 23.1% (27 of 117), respectively. Underestimation was 5.6-fold (odds ratio [OR] = 5.6; 95% confidence interval [CI]: 1.7, 18.3) and 3.6-fold (OR = 3.6; 95% CI: 1.2, 10) more likely in mass (n = 20 for ADH and n = 20 for DCIS) than in non-mass (n = 46 for ADH and n = 97 for DCIS), compared with nonunderestimation, in ADH and DCIS respectively. At multivariate analysis, the use of a 9- or 10-gauge needle versus a 7- or 8-gauge needle was also an independently associated with underestimation when a diagnosis of ADH was made at MR imaging-guided biopsy. No other parameters were associated with of ADH or DCIS upgrade at surgery. Conclusion The rates of underestimation in ADH and DCIS diagnosed at MR imaging-guided vacuum-assisted biopsy were high, at around 25%, and were significantly associated with the presence of a mass at MR imaging. © RSNA, 2016.

Le type de traitement d’un cancer du sein dépend de plusieurs paramètres que sont la taille de la tumeur, sa localisation, son caractère uni- ou multifocal et l’existence d’une poussée évolutive ou d’un envahissement ganglionnaire. Le résultat du prélèvement radioguidé est déterminant, en affirmant le diagnostic de malignité, mais également en fournissant des éléments diagnostiques et pronostiques essentiels (type de tumeur, grade, immunohistochimie). Connaître les particularités histologiques des tumeurs permet d’adapter la technique de prélèvement et d’optimiser sa représentativité. En cas de traitement néoadjuvant, la biopsie préthérapeutique est fondamentale car la tumeur peut se modifier sous traitement voire disparaître en cas de réponse complète. Dans cette indication, le prélèvement radioguidé est l’occasion de la pose d’un clip intratumoral, utile pour le repérage préopératoire. Enfin, l’atteinte ganglionnaire étant un facteur pronostique majeur, il est recommandé de prélever tout ganglion cliniquement ou radiologiquement suspect.

Following a mastectomy, the analysis of surgical specimens allows the pathologist to assess all the characteristics of the lesion which was resected and adjacent breast tissue. Two imperatives guide the pathologist throughout the management of these samples: maintain the best biological quality of the tissue and properly identify the suspicious lesion in the sample. Proper sample management will create the conditions for microscopic analysis and conducting laboratory tests on the one hand, and help the pathologist to be certain that the microscopic images he is analysing correspond exactly to the lesion. All results of these exams will be collated in the report and forwarded to the practitioner who will use them to determine the most suitable course of action and treatment if necessary. (C) 2015 Elsevier Masson SAS. All rights reserved.

Le cancer du sein associé à la grossesse est une pathologie rare mais grave, dont la fréquence est en augmentation. Son diagnostic est souvent porté avec retard du fait de difficultés spécifiques à cette période, aussi bien à l’examen clinique qu’en imagerie. Mammographie et échographie sont toutes deux nécessaires et complémentaires. Les caractéristiques histologiques et immunophénotypiques sont fréquemment défavorables. Une prise en charge multidisciplinaire rapide est essentielle.

Pregnancy associated breast cancer (PABC) is a rare but aggressive form of breast cancer, whose incidence is growing. A delayed diagnosis is frequent because of specific difficulties at clinical and radiological examination. Mammography and ultrasound are both necessary and complementary. Its histological and immunophenotypic characteristics are often unfavourable. A quick referral to multidisciplinary centers is hence very important. (C) 2013 Elsevier Masson SAS. All rights reserved.

PURPOSE:Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer with a poor prognosis. Locoregional staging is based on dynamic contrast-enhanced (DCE) CT or MRI. The aim of this study was to compare the performances of FDG PET/CT and DCE CT in locoregional staging of IBC and to assess their respective prognostic values.METHODS:The study group comprised 50 women (median age: 51 ± 11 years) followed in our institution for IBC who underwent FDG PET/CT and DCE CT scans (median interval 5 ± 9 days). CT enhancement parameters were net maximal enhancement, net early enhancement and perfusion.RESULTS:The PET/CT scans showed intense FDG uptake in all primary tumours. Concordance rate between PET/CT and DCE CT for breast tumour localization was 92%. No significant correlation was found between SUVmax and CT enhancement parameters in primary tumours (p > 0.6). PET/CT and DCE CT results were poorly correlated for skin infiltration (kappa = 0.19). Ipsilateral foci of increased axillary FDG uptake were found in 47 patients (median SUV: 7.9 ± 5.4), whereas enlarged axillary lymph nodes were observed on DCE CT in 43 patients. Results for axillary node involvement were fairly well correlated (kappa = 0.55). Nineteen patients (38%) were found to be metastatic on PET/CT scan with a significant shorter progression-free survival than patients without distant lesions (p = 0.01). In the primary tumour, no statistically significant difference was observed between high and moderate tumour FDG uptake on survival, using an SUVmax cut-off of 5 (p = 0.7 and 0.9), or between high and low tumour enhancement on DCE CT (p > 0.8).CONCLUSION:FDG PET/CT imaging provided additional information concerning locoregional involvement to that provided by DCE CT on and allowed detection of distant metastases in the same whole-body procedure. Tumour FDG uptake or CT enhancement parameters were not correlated and were not found to have any prognostic value.

Objective. - To review clinical and radiological aspects of an unusual lesion, mammary fibromatosis.Patients and methods. - We conducted a retrospective study of all cases diagnosed between 1993 and 2010, and reviewed all the clinical, radiological and pathological aspects of the lesions.Results. - Eleven cases, including nine women (one with bilateral fibromatosis) and one man, were identified. Patients were aged 21 to 78 and all presented with a palpable breast mass. In 50% of cases mammography detected the lesion, either as a spiculated mass (75%) or as a focal asymmetric density (25%). The lesion was always visible with sonography, and was usually (80%) suspicious. The lesion showed significant enhancement on CT or MRI in 83% of cases. The medium radiological size was 26 mm. Sonographically guided 14-gauge core needle biopsy suggested the diagnosis in all cases (5/5) and was able to assert it in three cases before excision. One recurrence was observed during the follow-up, which was of 3 to 8 years (medium follow-up 28 months).Conclusion. - Mammary fibromatosis often has a suspicious clinical and radiological appearance. Core biopsy is mandatory because it helps guiding the diagnosis before surgical excision. (C) 2012 Elsevier Masson SAS. All rights reserved.