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Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria

Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 6460847, 4 pages https://doi.org/10.1155/2019/6460847 Case Report Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria 1 1 1 2 Rawan Al khudari , Mohannad Homsi , Hasan Al zohaily , and Maher S. Saifo Faculty of Medicine, Damascus University, Damascus, Syria Department of Oncology, AL-Bairouni University Hospital, Damascus University, Damascus, Syria Correspondence should be addressed to Maher S. Saifo; maher.saifo@albairouni.com Received 16 March 2019; Accepted 25 July 2019; Published 10 September 2019 Academic Editor: Jose I. Mayordomo Copyright © 2019 Rawan Al khudari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bilateral breast cancers are rare cases encountered and are usually the same type in both sides. Only very few cases were reported to have different histological types of neoplasia involving sarcoma. Moreover, sarcomas rarely originate from the breast as a primary lesion whereas the common presentation is having angiosarcoma following radiotherapy. In this report, we present a rare case of a Syrian 43-year-old woman having two distinct primary lesions in the breasts: invasive ductal carcinoma and contralateral stromal sarcoma. 1. Introduction She is married with six children, no menstrual distur- bances, no history of breast trauma, no exposure to radiation, A breast stromal sarcoma is any tumor originating from the or no family history of breast cancer. intralobular stroma [1]. They were firstly defined in 1962 Clinical examination showed a 3 cm in diameter lump by Berg et al. as a “group of mesenchymal malignant tumors with irregular borders in the superior lateral quadrant of with fibrous, myxoid and adipose components excluding the right breast, with no swollen nodes. malignant cystosarcoma phylloides, lymphomas, and angio- A mammogram of the right breast showed a density in sarcomas” [2]. the superior lateral quadrant; the density corresponds with Primary malignant mesenchymal breast tumors (primary Breast Imaging Reporting and Data System (BIRADS) 4 (sus- breast sarcomas) are uncommon entities that represent 0.2– picious abnormality) [5] which required an excisional biopsy 1.0% of all breast malignancies [3]. Regarding that, bilateral to exclude malignancy. breast cancer is rare and only 2 to 11% of women diagnosed The lesion in the excisional biopsy was about 4.5 cm with breast cancer will develop contralateral breast cancer in (T ). The histopathology exam showed proliferation of their lifetime, [4] presenting with two different types of can- epithelial cells of the mammary canals infiltrating to the cers, one of which is stromal sarcoma, which is extremely rare. space between the canals (Figure 1) and in addition to In this article, we report a rare case from Syria presenting simultaneous ductal carcinoma in situ (Figure 2). CK7 with bilateral breast cancer, invasive ductal carcinoma, and staining proved carcinoma origin (Figure 3). These find- primary stromal sarcoma in the other side. ings revealed invasive ductal carcinoma grade III. A hor- monal receptor test was 10% positive for progesterone receptors and 10% positive for estrogen receptors; a 2. Case Report HER-2 test was negative. Staging depending on chest X- A 43-year-old white woman presented with a palpable lump ray, bone scintigraphy, and thoracoabdominal CT scan in the right breast to AL-Bairouni University Hospital in revealing no signs of metastatic disease suggested a September 2016. T N M score and a stage IIA tumor. 2 0 0 2 Case Reports in Oncological Medicine quadrant of the breast, there was no nipple retraction of the right breast and no swollen axillary lymph nodes on both sides. Differential diagnosis included the recurrence of the primary tumor. We repeated the imaging and histopathology study for confirmation. A mammogram showed on the right breast an asymmet- ric density in the upper outer quadrant that falls into the BIR- ADS 3 (probably benign) category suggesting recurrence. There was neither nipple retraction nor calcification. From the left breast mammogram, a heterogeneous density was noted in the upper outer quadrant. This had poorly defined margins (speculated) and appeared highly Figure 1: Invasive ductal carcinoma (H&E). infiltrative. Also, there was a small density with poorly defined margins in the central part, which corresponds to the BIRADS 4 category (suspicious abnormality) with thick- ened skin and mild nipple retraction, but no calcification, which prompted excisional biopsy from the left breast. Surprisingly, histopathology of excisional biopsy per- formed to the left breast mass showed high cellularity of spindle-shaped cells; the mass contained fatty tissue and showed an abundant mitotic activity (Figure 4). Immuno- histochemistry (IHC) showed negative results for epithelial markers, such as cytokeratin 7 (CK7) (Figure 5) and epithelial membrane antigen (EMA), leukocyte common antigen (LCA), and desmin, which in turn excluded carci- noma origin, lymphoma/leukaemia, and muscular origin, Figure 2: Magnified image showing ductal carcinoma in situ. respectively. Positive staining of CD10 (Figure 6) confirmed stromal origin confirming the diagnosis of high-grade stro- mal sarcoma of the breast. Repeating CT scan and scintigraphy showed no signs of metastatic disease. Consequently, she underwent bilateral mastectomy and bilateral axillary lymph node resection. Histopathology showed free surgical margins and no invaded nodes. In the follow-up, the patient had received hormonal therapy (Tamoxafen) after adjuvant chemotherapy: 8 cycles of Taxol 150 mg+Cisplatin 50 mg and 3 sessions of radiother- apy. The follow-up for 14 months showed no evidence of recurrence. Figure 3: CK7 staining with positive results indicating carcinoma. 3. Discussion This is the first case to be reported with concomitant contra- The patient received neoadjuvant chemotherapy for three lateral breast stromal sarcoma and carcinoma from Syria. months consisting four cycles of EC (epirubicin-cyclophos- When bilateral breast cancer is present, it is usually the same phamide) according to the National Comprehensive Cancer type for both breasts [7]. Network NCCN guideline [6]. Quadrantectomy was planned Reviewing the literature (PubMed and Google Scholar after the fourth dose. Unfortunately, due to issues related to search, March 2019), we found no identical cases of coexist- the war in Syria, there was no possible connection with the ing primary stromal sarcoma and invasive ductal carcinoma patient for about eight months which corrupted her treat- in distinct breasts. However, few similar cases reported bilat- ment plan. erally different types of cancer with sarcoma. In de Mello Later, in August 2017, 8 months after receiving the last et al.’s report [8], a 42-year-old woman had a lobular pleo- dose of chemotherapy, 11 months after the first presentation morphic carcinoma in the right breast, a different type of and mammogram, she presented with two lumps, one for carcinoma compared to that in our case, and a sarcoma in each breast. Physical examination showed palpable lesions; the left that was diagnosed histologically. the left breast lump was 3 cm in diameter in the superior On one hand, primary sarcomas can take various histo- lateral quadrant of the breast; with a mild nipple retraction logical types that often require IHC to differentiate [9], and without any discharge, the skin was normal. While the right secondary sarcomas often present as angiosarcoma, espe- breast lump was 2 cm in diameter in the superior lateral cially after radiation therapy of another tumor [10]. In our Case Reports in Oncological Medicine 3 metastasis and reducing the rate of locoregional recurrence [13]. The first cancer was diagnosed early in the disease course giving a good recovery chance. After presenting again with bilateral masses, the case necessitated a more radical surgery with adjuvant chemotherapy, radiotherapy, and hormonal therapy. In response to this management plan, she had a disease-free state for 14 months. 4. Conclusion This case presents a rare entity of bilaterally different types of Figure 4: H&E microscopic image of the left mass showing spindle- cancers including stromal breast sarcoma. This report high- shaped cells. lights the importance of a profound study of new lesions previously diagnosed as breast cancer lesions to not miss the diagnosis of different types of cancer and thus be wrongly treated. This is the first case from Syria to be reported. Conflicts of Interest There is no conflict of interest. Acknowledgments We would like to thank Dr. Fariz Al-Ahmad and Dr. Mousa Alali for their efforts in acquisition of histopathological approach to this case. Special thanks are due to Dr. Fatima Figure 5: Negative CK7 stain of the left mass. Abbass for her help in clinical information. References [1] J. C. Trent, R. S. Benjamin, and V. Valero, “Primary soft tissue sarcoma of the breast,” Current Treatment Options in Oncol- ogy, vol. 2, no. 2, pp. 169–176, 2001. [2] J. W. Berg, J. J. Decrosse, A. A. Fracchia, and J. Farrow, “Stro- mal sarcomas of the breast. A unified approach to connective tissue sarcomas other than cystosarcoma phyllodes,” Cancer, vol. 15, no. 2, pp. 418–424, 1962. [3] T. Cil, A. Altintas, S. Pasa, H. Buyukbayram, and A. Isikdogan, “Primary spindle cell sarcoma of the breast,” Breast Care, vol. 3, no. 3, pp. 197–199, 2008. Figure 6: CD10-positive staining for the left mass suggesting [4] Y. Chen, W. Thompson, R. Semenciw, and Y. Mao, “Epidemi- stromal origin. ology of contralateral breast cancer,” Cancer Epidemiology and Prevention Biomarkers, vol. 8, no. 10, pp. 855–861, 1999. [5] C. Balleyguier, S. Ayadi, K. Van Nguyen, D. Vanel, C. Dromain, and R. Sigal, “BIRADS classification in mammog- patient, it was important to do IHC to confirm the diagnosis raphy,” European Journal of Radiology, vol. 61, no. 2, pp. 192– as it is uncommon to be considered a different diagnosis in a 194, 2007. previous carcinoma patient who never received radiotherapy. [6] W. J. Gradishar, B. O. Anderson, R. Balassanian et al., “Breast On the other hand, the mainstay treatment in soft tissue cancer, version 4.2017, NCCN Clinical Practice Guidelines in sarcoma is surgery [4, 11, 12]. Axillary resection is not neces- Oncology,” Journal of the National Comprehensive Cancer sary, since sarcomas rarely invade the lymphatic system [3]. Network, vol. 16, no. 3, pp. 310–320, 2018. We followed these management protocols of surgery. How- [7] Z. El Hanchi, R. Berrada, A. Fadli et al., “Cancer du sein ever, axillary nodes were dissected due to the presence of con- bilatéral. Incidence et facteurs de risque,” Gynécologie Obsté- comitant carcinoma. trique & Fertilité, vol. 32, no. 2, pp. 128–134, 2004. Also, in high-risk cases, adjuvant and neoadjuvant che- [8] R. A. de Mello, P. Figueiredo, M. Marques, G. Sousa, motherapy and radiotherapy should be considered and T. Carvalho, and H. Gervásio, “Concurrent breast stroma sar- chemotherapy is the mainstay of treating widespread meta- coma and breast carcinoma: a case report,” Journal of Medical static cancer, whereas radiotherapy is preferred for lymphatic Case Reports, vol. 4, no. 1, 2010. 4 Case Reports in Oncological Medicine [9] H. Takahashi, S. Inaba, and H. Yabuki, “Two cases of stromal sarcoma of the breast,” Gan to kagaku ryoho. Cancer & chemo- therapy, vol. 43, no. 12, pp. 2424–2428, 2016. [10] N. Li, M. T. Cusidó, B. Navarro et al., “Breast sarcoma. A case report and review of literature,” International Journal of Sur- gery Case Reports, vol. 24, pp. 203–205, 2016. [11] P. J. Chuba, M. R. Hamre, J. Yap et al., “Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data,” Journal of Clinical Oncology: Official Journal of the Ameri- can Society of Clinical Oncology, vol. 23, no. 24, pp. 5534– 5541, 2005. [12] J. Skowronek and T. Piotrowski, “Bilateral breast cancer,” Neo- plasma, vol. 49, no. 1, pp. 49–54, 2002. [13] Y. W. Lum and L. Jacobs, “Primary breast sarcoma,” The Sur- gical Clinics of North America, vol. 88, no. 3, pp. 559–570, 2008, vi. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria

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Copyright © 2019 Rawan Al khudari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 6460847, 4 pages https://doi.org/10.1155/2019/6460847 Case Report Primary Stromal Breast Sarcoma with Concomitant Contralateral Carcinoma: A Rare Case from Syria 1 1 1 2 Rawan Al khudari , Mohannad Homsi , Hasan Al zohaily , and Maher S. Saifo Faculty of Medicine, Damascus University, Damascus, Syria Department of Oncology, AL-Bairouni University Hospital, Damascus University, Damascus, Syria Correspondence should be addressed to Maher S. Saifo; maher.saifo@albairouni.com Received 16 March 2019; Accepted 25 July 2019; Published 10 September 2019 Academic Editor: Jose I. Mayordomo Copyright © 2019 Rawan Al khudari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bilateral breast cancers are rare cases encountered and are usually the same type in both sides. Only very few cases were reported to have different histological types of neoplasia involving sarcoma. Moreover, sarcomas rarely originate from the breast as a primary lesion whereas the common presentation is having angiosarcoma following radiotherapy. In this report, we present a rare case of a Syrian 43-year-old woman having two distinct primary lesions in the breasts: invasive ductal carcinoma and contralateral stromal sarcoma. 1. Introduction She is married with six children, no menstrual distur- bances, no history of breast trauma, no exposure to radiation, A breast stromal sarcoma is any tumor originating from the or no family history of breast cancer. intralobular stroma [1]. They were firstly defined in 1962 Clinical examination showed a 3 cm in diameter lump by Berg et al. as a “group of mesenchymal malignant tumors with irregular borders in the superior lateral quadrant of with fibrous, myxoid and adipose components excluding the right breast, with no swollen nodes. malignant cystosarcoma phylloides, lymphomas, and angio- A mammogram of the right breast showed a density in sarcomas” [2]. the superior lateral quadrant; the density corresponds with Primary malignant mesenchymal breast tumors (primary Breast Imaging Reporting and Data System (BIRADS) 4 (sus- breast sarcomas) are uncommon entities that represent 0.2– picious abnormality) [5] which required an excisional biopsy 1.0% of all breast malignancies [3]. Regarding that, bilateral to exclude malignancy. breast cancer is rare and only 2 to 11% of women diagnosed The lesion in the excisional biopsy was about 4.5 cm with breast cancer will develop contralateral breast cancer in (T ). The histopathology exam showed proliferation of their lifetime, [4] presenting with two different types of can- epithelial cells of the mammary canals infiltrating to the cers, one of which is stromal sarcoma, which is extremely rare. space between the canals (Figure 1) and in addition to In this article, we report a rare case from Syria presenting simultaneous ductal carcinoma in situ (Figure 2). CK7 with bilateral breast cancer, invasive ductal carcinoma, and staining proved carcinoma origin (Figure 3). These find- primary stromal sarcoma in the other side. ings revealed invasive ductal carcinoma grade III. A hor- monal receptor test was 10% positive for progesterone receptors and 10% positive for estrogen receptors; a 2. Case Report HER-2 test was negative. Staging depending on chest X- A 43-year-old white woman presented with a palpable lump ray, bone scintigraphy, and thoracoabdominal CT scan in the right breast to AL-Bairouni University Hospital in revealing no signs of metastatic disease suggested a September 2016. T N M score and a stage IIA tumor. 2 0 0 2 Case Reports in Oncological Medicine quadrant of the breast, there was no nipple retraction of the right breast and no swollen axillary lymph nodes on both sides. Differential diagnosis included the recurrence of the primary tumor. We repeated the imaging and histopathology study for confirmation. A mammogram showed on the right breast an asymmet- ric density in the upper outer quadrant that falls into the BIR- ADS 3 (probably benign) category suggesting recurrence. There was neither nipple retraction nor calcification. From the left breast mammogram, a heterogeneous density was noted in the upper outer quadrant. This had poorly defined margins (speculated) and appeared highly Figure 1: Invasive ductal carcinoma (H&E). infiltrative. Also, there was a small density with poorly defined margins in the central part, which corresponds to the BIRADS 4 category (suspicious abnormality) with thick- ened skin and mild nipple retraction, but no calcification, which prompted excisional biopsy from the left breast. Surprisingly, histopathology of excisional biopsy per- formed to the left breast mass showed high cellularity of spindle-shaped cells; the mass contained fatty tissue and showed an abundant mitotic activity (Figure 4). Immuno- histochemistry (IHC) showed negative results for epithelial markers, such as cytokeratin 7 (CK7) (Figure 5) and epithelial membrane antigen (EMA), leukocyte common antigen (LCA), and desmin, which in turn excluded carci- noma origin, lymphoma/leukaemia, and muscular origin, Figure 2: Magnified image showing ductal carcinoma in situ. respectively. Positive staining of CD10 (Figure 6) confirmed stromal origin confirming the diagnosis of high-grade stro- mal sarcoma of the breast. Repeating CT scan and scintigraphy showed no signs of metastatic disease. Consequently, she underwent bilateral mastectomy and bilateral axillary lymph node resection. Histopathology showed free surgical margins and no invaded nodes. In the follow-up, the patient had received hormonal therapy (Tamoxafen) after adjuvant chemotherapy: 8 cycles of Taxol 150 mg+Cisplatin 50 mg and 3 sessions of radiother- apy. The follow-up for 14 months showed no evidence of recurrence. Figure 3: CK7 staining with positive results indicating carcinoma. 3. Discussion This is the first case to be reported with concomitant contra- The patient received neoadjuvant chemotherapy for three lateral breast stromal sarcoma and carcinoma from Syria. months consisting four cycles of EC (epirubicin-cyclophos- When bilateral breast cancer is present, it is usually the same phamide) according to the National Comprehensive Cancer type for both breasts [7]. Network NCCN guideline [6]. Quadrantectomy was planned Reviewing the literature (PubMed and Google Scholar after the fourth dose. Unfortunately, due to issues related to search, March 2019), we found no identical cases of coexist- the war in Syria, there was no possible connection with the ing primary stromal sarcoma and invasive ductal carcinoma patient for about eight months which corrupted her treat- in distinct breasts. However, few similar cases reported bilat- ment plan. erally different types of cancer with sarcoma. In de Mello Later, in August 2017, 8 months after receiving the last et al.’s report [8], a 42-year-old woman had a lobular pleo- dose of chemotherapy, 11 months after the first presentation morphic carcinoma in the right breast, a different type of and mammogram, she presented with two lumps, one for carcinoma compared to that in our case, and a sarcoma in each breast. Physical examination showed palpable lesions; the left that was diagnosed histologically. the left breast lump was 3 cm in diameter in the superior On one hand, primary sarcomas can take various histo- lateral quadrant of the breast; with a mild nipple retraction logical types that often require IHC to differentiate [9], and without any discharge, the skin was normal. While the right secondary sarcomas often present as angiosarcoma, espe- breast lump was 2 cm in diameter in the superior lateral cially after radiation therapy of another tumor [10]. In our Case Reports in Oncological Medicine 3 metastasis and reducing the rate of locoregional recurrence [13]. The first cancer was diagnosed early in the disease course giving a good recovery chance. After presenting again with bilateral masses, the case necessitated a more radical surgery with adjuvant chemotherapy, radiotherapy, and hormonal therapy. In response to this management plan, she had a disease-free state for 14 months. 4. Conclusion This case presents a rare entity of bilaterally different types of Figure 4: H&E microscopic image of the left mass showing spindle- cancers including stromal breast sarcoma. This report high- shaped cells. lights the importance of a profound study of new lesions previously diagnosed as breast cancer lesions to not miss the diagnosis of different types of cancer and thus be wrongly treated. This is the first case from Syria to be reported. Conflicts of Interest There is no conflict of interest. Acknowledgments We would like to thank Dr. Fariz Al-Ahmad and Dr. Mousa Alali for their efforts in acquisition of histopathological approach to this case. Special thanks are due to Dr. Fatima Figure 5: Negative CK7 stain of the left mass. Abbass for her help in clinical information. References [1] J. C. Trent, R. S. Benjamin, and V. Valero, “Primary soft tissue sarcoma of the breast,” Current Treatment Options in Oncol- ogy, vol. 2, no. 2, pp. 169–176, 2001. [2] J. W. Berg, J. J. Decrosse, A. A. Fracchia, and J. Farrow, “Stro- mal sarcomas of the breast. A unified approach to connective tissue sarcomas other than cystosarcoma phyllodes,” Cancer, vol. 15, no. 2, pp. 418–424, 1962. [3] T. Cil, A. Altintas, S. Pasa, H. Buyukbayram, and A. Isikdogan, “Primary spindle cell sarcoma of the breast,” Breast Care, vol. 3, no. 3, pp. 197–199, 2008. Figure 6: CD10-positive staining for the left mass suggesting [4] Y. Chen, W. Thompson, R. Semenciw, and Y. Mao, “Epidemi- stromal origin. ology of contralateral breast cancer,” Cancer Epidemiology and Prevention Biomarkers, vol. 8, no. 10, pp. 855–861, 1999. [5] C. Balleyguier, S. Ayadi, K. Van Nguyen, D. Vanel, C. Dromain, and R. Sigal, “BIRADS classification in mammog- patient, it was important to do IHC to confirm the diagnosis raphy,” European Journal of Radiology, vol. 61, no. 2, pp. 192– as it is uncommon to be considered a different diagnosis in a 194, 2007. previous carcinoma patient who never received radiotherapy. [6] W. J. Gradishar, B. O. Anderson, R. Balassanian et al., “Breast On the other hand, the mainstay treatment in soft tissue cancer, version 4.2017, NCCN Clinical Practice Guidelines in sarcoma is surgery [4, 11, 12]. Axillary resection is not neces- Oncology,” Journal of the National Comprehensive Cancer sary, since sarcomas rarely invade the lymphatic system [3]. Network, vol. 16, no. 3, pp. 310–320, 2018. We followed these management protocols of surgery. How- [7] Z. El Hanchi, R. Berrada, A. Fadli et al., “Cancer du sein ever, axillary nodes were dissected due to the presence of con- bilatéral. Incidence et facteurs de risque,” Gynécologie Obsté- comitant carcinoma. trique & Fertilité, vol. 32, no. 2, pp. 128–134, 2004. Also, in high-risk cases, adjuvant and neoadjuvant che- [8] R. A. de Mello, P. Figueiredo, M. Marques, G. Sousa, motherapy and radiotherapy should be considered and T. Carvalho, and H. Gervásio, “Concurrent breast stroma sar- chemotherapy is the mainstay of treating widespread meta- coma and breast carcinoma: a case report,” Journal of Medical static cancer, whereas radiotherapy is preferred for lymphatic Case Reports, vol. 4, no. 1, 2010. 4 Case Reports in Oncological Medicine [9] H. Takahashi, S. Inaba, and H. Yabuki, “Two cases of stromal sarcoma of the breast,” Gan to kagaku ryoho. Cancer & chemo- therapy, vol. 43, no. 12, pp. 2424–2428, 2016. [10] N. Li, M. T. Cusidó, B. Navarro et al., “Breast sarcoma. A case report and review of literature,” International Journal of Sur- gery Case Reports, vol. 24, pp. 203–205, 2016. [11] P. J. Chuba, M. R. Hamre, J. Yap et al., “Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data,” Journal of Clinical Oncology: Official Journal of the Ameri- can Society of Clinical Oncology, vol. 23, no. 24, pp. 5534– 5541, 2005. [12] J. Skowronek and T. Piotrowski, “Bilateral breast cancer,” Neo- plasma, vol. 49, no. 1, pp. 49–54, 2002. [13] Y. W. Lum and L. Jacobs, “Primary breast sarcoma,” The Sur- gical Clinics of North America, vol. 88, no. 3, pp. 559–570, 2008, vi. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

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Published: Sep 10, 2019

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