Sarcoma

Sarcoma

Sarcomas, most commonly fibrosarcoma and angiosarcoma, may arise de novo from the mesenchymal tissues of the breast. Enrico Sertoli , 1842–1910, Italian physiologist, discovered the Sertoli cells of the testis in 1865. Thomas Hodgkin , 1798–1866, lecturer in morbid anatomy and curator of the museum, Guy’s Hospital, London, UK, described Hodgkin’s lymphoma in 1832. Summary box 58.6 Prognosis /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - /uni25CF Some genetic conditions (Li–Fraumeni, neurofibromatosis type 1), exposure to alkylating agents, vinyl chloride or arsenic, - prior radiotherapy (e.g. for Hodgkin’s lymphoma) and chronic lymphoedema are associated with the development of sarcoma. Angiosarcoma ( Figure 58.40 ) is the most aggressive of all breast tumours and arises from the endothelial cell lining of vascular or lymphatic channels. Angiosarcoma is associated with prior radiotherapy and carries a very poor prognosis.

Figure 58.39 Carcinoma of the male left breast (courtesy of Professor Mike Dixon). Disease factors Patient factors a Size of tumour Younger age Stage of disease Premenopausal a women Axillary lymph node involvement a BRCA -associated Grade of tumour tumour Histopathological variant Family history of (metaplastic carcinoma is breast cancer aggressive): Prior history of Her2/neu positive and triple breast cancer negative Obesity, sedentary Presence of lymphovascular lifestyle invasion Failure to complete Extensive DCIS component intended treatment High Ki-67 index DCIS, ductal carcinoma in situ . a The Nottingham prognostic index (NPI) is used to determine prognosis following surgery. It is calculated using tumour size /uni00A0 (S), number of involved lymph nodes (N) and tumour grade (G). NPI = (0.2 /uni00A0×/uni00A0 S) /uni00A0 + /uni00A0 N /uni00A0 + /uni00A0 G. Patients are grouped into four categories according to the NPI score: I (excellent) ≤ 2.4; II (good) >2.4 but ≤ 3.4; III (moderate) >3.4 but ≤ 5.4; and IV (poor) >5.4.