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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 69, Num. 3, 2007, pp. 117-117

Indian Journal of Surgery, Vol. 69, No. 3, May-June, 2007, pp. 117

Letter To Editor

Malignant adenomyoepithelioma of the breast

Tewari Mallika

Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005
Correspondence Address:Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005 mallika_vns@satyam.net.in

Code Number: is07038

Related Article : is07004

Sir,

I read with interest the article by Attili et al.[1] in the recent issue of the IJS. We also have the experience of two such cases at our department who were diagnosed only after histopathological examination.

However, I fail to understand what made the authors do a mammogram, a computed tomography (CT) of the thorax and abdomen and a bone scan. The examination findings (though not clearly stated) revealed a breast lump about 4 cm in size. Even by staging the patient had a stage IIB disease with normal hematologic and biochemical parameters.

As per the NCCN (National Comprehensive Cancer Network) Clinical Practice Guidelines on Breast Cancer 2007 [2] for patients in Stage I (T1N0M0), IIA (T0N1M0, T1N1M0, T2N0M0) and IIB (T2N1M0, T3N0M0, T3N1M0), the recommended investigations are as follows:

  1. History and physical examination
  2. Complete blood count, platelets
  3. Liver function tests (LFTs)
  4. Chest imaging
  5. Diagnostic bilateral mammogram or ultrasound as necessary
  6. Pathology review
  7. Determination of estrogen receptor (ER) / progesterone receptor (PR) / human epithelial growth factor receptor 2 (Her-2) status
  8. Breast magnetic resonance imaging (MRI) (optional)
  9. Bone scan(optional) (Indicated if localized symptoms or elevated alkaline phosphatase or if T3N1M0) (category IIB)
  10. Abdominal CT or ultrasound (US) or MRI (optional for stage IIA or IIB, indicated if elevated alkaline phosphatase, abnormal LFTs, abdominal symptoms, abnormal physical examination of the abdomen or if T3N1M0) (category IIB)

The Indian Comprehensive Cancer Network Guidelines (ICCN) on Breast Cancer (2005) [3] advise the following for diagnosis of operable breast cancer (T < 5 cm ± mobile lymph nodes):

Diagnosis

  • Physical examination
  • Optional (mammography / ultrasonography)-include both axillae.

Tissue Diagnosis

Fine needle aspiration cytology/core biopsy

  • Excision biopsy
  • Frozen section
  • Incision biopsy (only when neoadjuvant therapy is planned)
  • Staging: metastatic workup, not mandatory

References

1.Attili VS, Saini K, Lakshmaiah CK, Batra U, Malathi M, Ramachandra C. Malignant adenomyoepithelioma of the breast. Indian J Surg 2007;69:14-6.  Back to cited text no. 1    
2.NCCN Clinical Practice Guidelines in Oncology. Version 1.2007  Back to cited text no. 2    
3.ICCN Clinical Guidelines on common Cancers in India, BMCHRC: Jaipur; Oct. 22-23, 2005.  Back to cited text no. 3    

Copyright 2007 - Indian Journal of Surgery

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