Evaluation of clinico: Pathologic findings of breast carcinoma in a general hospital in Southern India
Original Article
Mohapatra M, Satyanarayana S Department of Pathology, Ganni Shubha Laxmi Medical College and General Hospital, Andhra Pradesh, India Correspondence to: Dr. Manisha Mohapatra, E‑mail: [email protected]
Abstract BACKGROUND AND OBJECTIVES: Breast cancer is the second most common cancer in the Indian female population. As per our hospital data, breast cancer is also found to be the second leading malignancy in women. Hence, we undertook this study to evaluate the clinical profile, histopathologic types, grade, stage and the prognosis of the disease in our patients. Majority of our patients are from rural areas. MATERIALS AND METHODS: This study was undertaken over a period of three years comprising of 178 patients who underwent modified radical mastectomy following preliminary diagnosis of carcinoma on fine needle aspiration cytology or histopathological examination of the lumpectomy or trucut biopsy specimens. Clinico‑pathological evaluation was done in all of these cases following standard protocols. RESULT: The study comprised of 175 female patients and 3 male patients in the age range of 28 to 76 years. Majority (111/62.3%) of the cases were within the age range of 31‑50 years of age with mean age of 48.7 years. Two females had bilateral breast cancer and one female had synchronous papillary serous cystadenocarcinoma of the ovary. Invasive ductal carcinoma no special type was the most common histopathologic pattern, and was seen in 172 (95.5%) cases. Most tumors were Scarff Bloom Richardson grade II and American Joint Committee on Cancer pathologic stage II. Prognostically, majority of tumors (49.5%) was assessed as ‘good’ as per the Nottingham prognostic index score. CONCLUSIONS: This study gave an insight to the clinico‑pathological profile of breast cancer in our area. Long term study with follow up of the patient is needed for better understanding of the case. Key Words: Breast cancer, grading, histopathology, staging
Introduction Worldwide, breast cancer is the most common form of cancer in women and listed as second leading cause of cancer death among women.[1,2] Early detection with screening mammography and multimodality treatment has reduced the cancer mortality in western countries; however, it still continues to have a high prevalence in the developing countries. Every year 75,000 new cases of breast cancer are diagnosed in Indian women,[3] and it is regarded as the most common cancer in women in many metropolitan cities such as New Delhi, Mumbai, Ahmadabad, Kolkata and Trivandrum, and the second most common cancer in the rest parts of the country.[4,5] The pathogenesis of breast cancer is complex and many factors, such as, genetic, dietary, environmental and life style related have been extensively studied and implicated. The prognosis and treatment of the disease Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.123594 PMID: *******
Indian Journal of Cancer | October–December 2013 | Volume 50 | Issue 4
depends on various parameters such as the tumor size, lymph node status, histopathologic type, the grade and stage of the cancer. As per our hospital data, breast cancer is the second most frequently observed malignancy in females, and second to cervical cancer constituting 15.0% of all cancer cases. Hence, the present study was undertaken to include patients from November 2007 to November 2010 to characterize the clinical profile, histopathologic types, grades and stage of the disease and to assess the prognosis of the disease in our patients. Materials and Methods A total number of 231 cases confirmed as carcinoma breast on histopathological examination of modified radical mastectomy (MRM), trucut biopsy and lumpectomy specimens during the study period were reviewed. Out of 231 cases, 178 cases that underwent MRM were selected for the present study. Two of the cases had bilateral carcinoma, and thus the total sample size was of 180 MRM specimens. Detailed clinical examination was done in all 178 cases. Histopathological evaluation of the 180 MRM specimens was done from paraffin embedded sections stained by Haematoxylin and Eosin (H and E) stain following the standard 297
Mohapatra and Satyanarayana: Breast cancer, grading, histopathology, staging
protocol. Histopathological grading of the tumor based on Scarff Bloom Richardson’s (SBR) grading system and TNM staging [where, T describes the size of the tumor and whether it has invaded nearby tissue, N describes regional lymph nodes that are involved, M describes distant metastasis (spread of cancer from one body part to another)] based on American Joint Committee on Cancer (AJCC) was done in all tumors.[6,7] The prognosis of all of these cases was assessed by Nottingham prognostic index (NPI) scoring system.[8] Results The study comprised of 178 cases of which 175 (98.3%) were females and 3 (1.7%) were males. The age of the patients ranged from 28 to 76 years with mean age of 48.7 years. Majority of the patients (111/178, 62.3%) were between 31‑50 years of age, 61 (34.3%) cases above 50 years and 6 (3.4%) cases were below 30 years of age [Figure 1]. The mean age of breast cancer seen in the males was 52.6 years. Two of our female patients had carcinoma involving both the breasts. Table I discerns the salient findings of histopathologic examination of the total 180 specimens. The most common site of tumor was the upper outer quadrant (UOQ) accounting for 65.0% of all the cases. Predominantly the tumors were of solid type, seen in 175 out of 180 specimens (97.2%), whereas both solid and cystic type of growth were seen in rest 5 (2.8%) of the tumors [Figure 2a and b]. Five percent of the tumors had ulceration of the overlying skin and 1.1% tumors showed fungating type growth [Figure 2c and d]. The size of the tumors varied from 1.0 cm to 10.0 cm, with majority (76.6%) of the tumors belonging to T2 (2.0 to 5.0 cm) stage, followed by T3 (5.0 to 9.0 cm) and T1 (
Original Article
Mohapatra M, Satyanarayana S Department of Pathology, Ganni Shubha Laxmi Medical College and General Hospital, Andhra Pradesh, India Correspondence to: Dr. Manisha Mohapatra, E‑mail: [email protected]
Abstract BACKGROUND AND OBJECTIVES: Breast cancer is the second most common cancer in the Indian female population. As per our hospital data, breast cancer is also found to be the second leading malignancy in women. Hence, we undertook this study to evaluate the clinical profile, histopathologic types, grade, stage and the prognosis of the disease in our patients. Majority of our patients are from rural areas. MATERIALS AND METHODS: This study was undertaken over a period of three years comprising of 178 patients who underwent modified radical mastectomy following preliminary diagnosis of carcinoma on fine needle aspiration cytology or histopathological examination of the lumpectomy or trucut biopsy specimens. Clinico‑pathological evaluation was done in all of these cases following standard protocols. RESULT: The study comprised of 175 female patients and 3 male patients in the age range of 28 to 76 years. Majority (111/62.3%) of the cases were within the age range of 31‑50 years of age with mean age of 48.7 years. Two females had bilateral breast cancer and one female had synchronous papillary serous cystadenocarcinoma of the ovary. Invasive ductal carcinoma no special type was the most common histopathologic pattern, and was seen in 172 (95.5%) cases. Most tumors were Scarff Bloom Richardson grade II and American Joint Committee on Cancer pathologic stage II. Prognostically, majority of tumors (49.5%) was assessed as ‘good’ as per the Nottingham prognostic index score. CONCLUSIONS: This study gave an insight to the clinico‑pathological profile of breast cancer in our area. Long term study with follow up of the patient is needed for better understanding of the case. Key Words: Breast cancer, grading, histopathology, staging
Introduction Worldwide, breast cancer is the most common form of cancer in women and listed as second leading cause of cancer death among women.[1,2] Early detection with screening mammography and multimodality treatment has reduced the cancer mortality in western countries; however, it still continues to have a high prevalence in the developing countries. Every year 75,000 new cases of breast cancer are diagnosed in Indian women,[3] and it is regarded as the most common cancer in women in many metropolitan cities such as New Delhi, Mumbai, Ahmadabad, Kolkata and Trivandrum, and the second most common cancer in the rest parts of the country.[4,5] The pathogenesis of breast cancer is complex and many factors, such as, genetic, dietary, environmental and life style related have been extensively studied and implicated. The prognosis and treatment of the disease Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.123594 PMID: *******
Indian Journal of Cancer | October–December 2013 | Volume 50 | Issue 4
depends on various parameters such as the tumor size, lymph node status, histopathologic type, the grade and stage of the cancer. As per our hospital data, breast cancer is the second most frequently observed malignancy in females, and second to cervical cancer constituting 15.0% of all cancer cases. Hence, the present study was undertaken to include patients from November 2007 to November 2010 to characterize the clinical profile, histopathologic types, grades and stage of the disease and to assess the prognosis of the disease in our patients. Materials and Methods A total number of 231 cases confirmed as carcinoma breast on histopathological examination of modified radical mastectomy (MRM), trucut biopsy and lumpectomy specimens during the study period were reviewed. Out of 231 cases, 178 cases that underwent MRM were selected for the present study. Two of the cases had bilateral carcinoma, and thus the total sample size was of 180 MRM specimens. Detailed clinical examination was done in all 178 cases. Histopathological evaluation of the 180 MRM specimens was done from paraffin embedded sections stained by Haematoxylin and Eosin (H and E) stain following the standard 297
Mohapatra and Satyanarayana: Breast cancer, grading, histopathology, staging
protocol. Histopathological grading of the tumor based on Scarff Bloom Richardson’s (SBR) grading system and TNM staging [where, T describes the size of the tumor and whether it has invaded nearby tissue, N describes regional lymph nodes that are involved, M describes distant metastasis (spread of cancer from one body part to another)] based on American Joint Committee on Cancer (AJCC) was done in all tumors.[6,7] The prognosis of all of these cases was assessed by Nottingham prognostic index (NPI) scoring system.[8] Results The study comprised of 178 cases of which 175 (98.3%) were females and 3 (1.7%) were males. The age of the patients ranged from 28 to 76 years with mean age of 48.7 years. Majority of the patients (111/178, 62.3%) were between 31‑50 years of age, 61 (34.3%) cases above 50 years and 6 (3.4%) cases were below 30 years of age [Figure 1]. The mean age of breast cancer seen in the males was 52.6 years. Two of our female patients had carcinoma involving both the breasts. Table I discerns the salient findings of histopathologic examination of the total 180 specimens. The most common site of tumor was the upper outer quadrant (UOQ) accounting for 65.0% of all the cases. Predominantly the tumors were of solid type, seen in 175 out of 180 specimens (97.2%), whereas both solid and cystic type of growth were seen in rest 5 (2.8%) of the tumors [Figure 2a and b]. Five percent of the tumors had ulceration of the overlying skin and 1.1% tumors showed fungating type growth [Figure 2c and d]. The size of the tumors varied from 1.0 cm to 10.0 cm, with majority (76.6%) of the tumors belonging to T2 (2.0 to 5.0 cm) stage, followed by T3 (5.0 to 9.0 cm) and T1 (
