Introduction: We present the case of a 65 years- old woman who was admitted with a severe macrocytic anemia Hb= 5.7g/dl and diffuse bone pain. Biologically she has moderate thrombocytopenia 35 000/µl, a hepatic cytolysis and cholestatic syndrome. Material and method: The patient was extensively evaluated before presentation for a mild iron - deficiency anemia for which she underwent endoscopic examination of the upper and lower gastrointestinal tract- normal. The bone marrow aspiration on admission revealed a marked hyperplasia of the erythroblastic line with ~50% basophilic erythroblasts suggesting a regenerative erythroid hyperplasia. These changes along with the marked reticulocytosis on the peripheral blood smear oriented us towards a hemolytic anemia; Folic acid, vitamin B12, autoimmune tests and hemolytic tests were all normal. We continued the investigations with a thoraco-abdomino- pelvic computed tomography which identified diffuse demineralization, vertebral compactation and pelvic stress fractures. The breast examination revealed a right breast nodule, but the breast ultrasonography pleaded for benignity. Lacking a clear definitive diagnosis we decided to perform a bone marrow biopsy. Results: The osteo- medullary biopsy pointed towards a medullar invasion from a lobular mammary carcinoma; In these circumstances we performed an ultrasound guided biopsy of the right mammary lump thus histologically confirming a tumoral invasion of the bone marrow with subsequent anemia. The patient started chemotherapy in the Oncology ward. Conclusion: The particularity of this case consists in the pattern of anemia, which initially seemed iron deficient and afterwards macrocytic – apparently hemolytic and was actually due to the tumoral medullar invasion and also the nonspecific ultrasonographic appearance of the breast tumor.
Breast carcinoma represents the leading cause of oncologic mortality for women. Due to therapeutic and diagnostic advances, the mortality and morbidity in the last decade declined, but breast cancer still has a great impact on quality of life and also on medical service cost. In the light of these facts, an integrated approach, considering histopathology features, molecular profiles and corroboration with clinical and imagistic data is necessary. A descriptive retrospective one-year study analyzed the breast cancer heterogeneity in 121 cases registered in the Pathology Department of the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate histopathological, immunohistochemically, clinical and imagistic aspects of breast cancer considering the current molecular classification (Luminal A, Luminal B, HER2 enriched and triple negative/basal like). Our assay revealed that most prevalent histotype was NST (no special type) followed by invasive lobular carcinoma. Considering the molecular pattern, the most common was luminal B. Triple negative basal like and HER 2-enriched were correlated with an aggressive morphologic pattern and lymph-nodes positivity. Considering the imagistic acquisitions, mammography proved to be the most accurate technique for measuring the dimension of NST. In conclusion, breast carcinoma is a heterogeneous disease that needs an integrated approach and personalized treatment based on the histopathologic and molecular features. Considering the great number of advanced stages as diagnosis, a national screening program for breast cancer is imperiously needed.
Angiosarcoma is a malignant tumor derived from the endothelium of the blood and lymphatic vessels. Its aggressive behavior results in a poor prognosis for the patients. Radiation-associated angiosarcoma is a rare recently described particular subtype of angiosarcoma best shown in patients after treatment of breast cancer. The latency period of development is approximately 8 years, thus the 5-year standard follow-up after mammary neoplasm therapy needs to be extended up to 10 years. Radiotherapy is an independent risk factor for angiosarcoma development. Rapid diagnosis is essential for prompt therapeutical intervention to improve the patient’s prognosis. The importance of early diagnosis is emphasized by a case of a 54 years old woman, with a diagnosis of breast cancer treated by sectorectomy and radiotherapy 7 years prior, presenting to our Dermatology Department for the recent occurence of erythemato-violaceous cutaneous patches on the area subjected to radiotherapy.
Breast cancer remains a significant health concern, with predictions indicating a rise in global incidence. While the primary focus is on oncological radicality, the aesthetic and psychological impacts of surgical interventions, such as radical mastectomy, cannot be ignored. This study, conducted over 8 years, aimed to identify factors that can prevent unnecessary lymphadenectomy. The research analyzed various parameters, including age, BMI, tumor size, and immunohistochemistry, to determine their correlation with axillary lymph node invasion. The results highlighted the importance of tumor size and estrogen receptor status in predicting axillary lymph node metastasis. The study underscores the value of sentinel lymph node biopsy in early breast cancer treatment, emphasizing its benefits over complete axillary lymph node dissection.
