41 A Case Series of Sarcomas

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 48

Background

Breast sarcomas are malignancies of mesenchymal cell lineages. They are rare and generally more aggressive than breast adenocarcinomas. The primary form arises de novo, and the secondary form is often treatment-related. Management remains highly variable. Experiences from retrospective studies and case reports can help identify patterns.

Methods

Summary of the 5 Patients' Breast Sarcoma Histology, Size, Grade, Staging, and Margins

Summary of the 5 Patients' Breast Sarcoma Histology, Size, Grade, Staging, and Margins

We discuss 5 cases: (1) 86F with a secondary angiosarcoma 6 years after lumpectomy/radiation to treat left breast mucinous carcinoma; (2) 44F with a 2-year history of an enlarging, biopsy-proven left breast angiosarcoma; (3) 39F with a 2-month history of an enlarging, biopsy-proven right breast angiosarcoma; (4) 60F with enlarging left breast mass on mammograms over 2 years with biopsies showing focal bone metaplasia; and (5) 59F with recurrent left breast phyllodes tumor.

Results

Patients 1 to 3 underwent mastectomy. With negative margins, patient 1 had a latissimus flap to cover the large wound. Three months later, she underwent excision of recurrent skin lesions and radiation. She declined palliative chemotherapy. Her cancer was upstaged from IIIB to IV after biopsy-confirmed liver metastasis at 1 year. Patient 2 completed gemcitabine/docetaxel and doxorubicin treatment but progressed from stage IIIA to IV with osseous and liver metastases at 1 year and died. Patient 3 was staged IIIA with medical and radiation oncology referrals. Patient 4 underwent an excisional biopsy, which returned spindle cell neoplasm with bone and cartilage differentiation. Despite margin clearance after re-excision and 2 cycles of gemcitabine/docetaxel to treat malignant phyllodes (initial diagnosis slightly favored over metaplastic carcinoma), she had a mastectomy for recurrence 6 months later. Immunohistochemistry showed keratin expression more characteristic of metaplastic carcinoma. The patient will initiate pembrolizumab. Patient 5 had lumpectomy. Her phyllodes tumor showed marked stromal atypia but was classified borderline given no overgrowth relative to epithelium and its liposarcoma differentiation, which has low malignant potential. A 1-cm margin was assured after re-excision. She will continue mammogram surveillance.

Conclusions

Large, high-grade histology such as angiosarcoma or spindle cell confer guarded prognosis. Their presence often warrants mastectomy +/- chemotherapy or radiation. Lumpectomy is considered for smaller tumors with favorable histology such as liposarcoma and benign/borderline phyllodes. Negative margin status is essential for disease control.

Articles in this issue

1 Centrally Located Breast Cancer Is More Aggressive in Bahraini Patients
1 Centrally Located Breast Cancer Is More Aggressive in Bahraini Patients
2 Is Laterality in Breast Cancer Still Worth Studying? Local Experience in Bahrain
2 Is Laterality in Breast Cancer Still Worth Studying? Local Experience in Bahrain
3 Gender Disparities in the  National Institutes of Health  Funding for Breast Cancer
3 Gender Disparities in the National Institutes of Health Funding for Breast Cancer
4 Bacopaside: Exploring Its Potential in Addressing Chemoresistance and Modulating Doxorubicin Accumulation in Triple-Negative Breast Cancer Cells
4 Bacopaside: Exploring Its Potential in Addressing Chemoresistance and Modulating Doxorubicin Accumulation in Triple-Negative Breast Cancer Cells
5 Predictors of Axillary Complete Pathologic Response in Hormone Receptor–Positive, HER2-Negative, Clinically Node-Positive Breast Cancer
5 Predictors of Axillary Complete Pathologic Response in Hormone Receptor–Positive, HER2-Negative, Clinically Node-Positive Breast Cancer
6 Treatment Outcomes of the KEYNOTE-522 Regimen in an Ethnically Diverse Patient Population
6 Treatment Outcomes of the KEYNOTE-522 Regimen in an Ethnically Diverse Patient Population
7 Real-World Efficacy and Adverse Events of Neoadjuvant Immunotherapy in Early-Stage Triple-Negative Breast Cancer Patients: A Multicenter Experience
7 Real-World Efficacy and Adverse Events of Neoadjuvant Immunotherapy in Early-Stage Triple-Negative Breast Cancer Patients: A Multicenter Experience
8 Using a Liquid Biopsy Mediated Approach for Determination of HER2 Amplification Status in Patient Samples
8 Using a Liquid Biopsy Mediated Approach for Determination of HER2 Amplification Status in Patient Samples
9 Elacestrant (ELA) vs Standard-of-Care (SOC) in ER+/HER2–Advanced (adv) or Metastatic Breast Cancer (mBC) with ESR1 Mutation (ESR1-mut): Key Biomarkers and Clinical Subgroup Analyses From the Phase 3 EMERALD Trial
9 Elacestrant (ELA) vs Standard-of-Care (SOC) in ER+/HER2–Advanced (adv) or Metastatic Breast Cancer (mBC) with ESR1 Mutation (ESR1-mut): Key Biomarkers and Clinical Subgroup Analyses From the Phase 3 EMERALD Trial
10 Real-World Effectiveness of Palbociclib (PAL) Plus Aromatase Inhibitors (AI) in Patients With Metastatic Breast Cancer (MBC) and Cardiovascular Diseases (CVD)
10 Real-World Effectiveness of Palbociclib (PAL) Plus Aromatase Inhibitors (AI) in Patients With Metastatic Breast Cancer (MBC) and Cardiovascular Diseases (CVD)
11 Phase 3 Study of Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy, Followed by Adjuvant Pembrolizumab or Placebo Plus Endocrine Therapy for Early-Stage High-Risk ER+/HER2– Breast Cancer: KEYNOTE-756
11 Phase 3 Study of Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy, Followed by Adjuvant Pembrolizumab or Placebo Plus Endocrine Therapy for Early-Stage High-Risk ER+/HER2– Breast Cancer: KEYNOTE-756
12 EMERALD Trial Analysis of Patient-Reported Outcomes (PROs) in Patients (pts) With ER+/HER2- Advanced or Metastatic Breast  Cancer (mBC) Comparing Oral Elacestrant vs Standard-of-Care (SoC) Endocrine Therapy
12 EMERALD Trial Analysis of Patient-Reported Outcomes (PROs) in Patients (pts) With ER+/HER2- Advanced or Metastatic Breast Cancer (mBC) Comparing Oral Elacestrant vs Standard-of-Care (SoC) Endocrine Therapy
13 The Cause and Eradication of Breast Cancer
13 The Cause and Eradication of Breast Cancer
14 Outcomes With First-Line (1L) Ribociclib (RIB) + Endocrine Therapy (ET) vs Physician’s Choice Combination Chemotherapy (combo CT) by Age in Pre/Perimenopausal Patients (pts) With Aggressive HR+/HER2– Advanced Breast Cancer (ABC): A Subgroup Analysis of the RIGHT Choice Trial
14 Outcomes With First-Line (1L) Ribociclib (RIB) + Endocrine Therapy (ET) vs Physician’s Choice Combination Chemotherapy (combo CT) by Age in Pre/Perimenopausal Patients (pts) With Aggressive HR+/HER2– Advanced Breast Cancer (ABC): A Subgroup Analysis of the RIGHT Choice Trial
15 Concurrent Use of Abemaciclib and Radiation Therapy (RT) Among Patients With HR+, HER2– Metastatic Breast Cancer (MBC): Real-World Utilization and Safety
15 Concurrent Use of Abemaciclib and Radiation Therapy (RT) Among Patients With HR+, HER2– Metastatic Breast Cancer (MBC): Real-World Utilization and Safety
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