AN UNUSUAL LARGE SIZE DUCTAL CARCINOMA IN SITU IN A PATIENT ON LITHIUM THERAPY: A CASE REPORT WITH LITERATURE REVIEW
Keywords:Ductal carcinoma in situ;, Lithium;, Breast
AbstractBackground: Ductal carcinoma in situ (DCIS) is the earliest and most curable form of breast cancer. Patients who harbour this disease for quite some time usually have micro invasion by virtue of high-grade disease or big size. Herein, we report a case of 56-year-old postmenopausal woman presenting with a one-year history of blood-stained nipple discharge from right breast. She was a known case of depression receiving oral anti-depressants containing lithium for 20 years. Her mammogram was performed followed by ultrasound breast. Mammogram identified suspicious clusters of micro calcifications hence subjected to stereotactic core biopsy which revealed two separate foci of high-grade DCIS. Therefore, based on her clinical, radiological, and pathological findings she was subjected to mastectomy and sentinel node biopsy. Final histopathology showed big DCIS (10×8×3 cm in size) with immunohistochemical stains confirmed no invasive focus on extensive sampling. Therefore, we postulated that it might be correlated to the use of Lithium which has anti-cancer properties.
Chiappa C, Bonetti A, Jaber GJ, De Berardinis V, Bianchi V, Rovera F. Pure ductal carcinoma in situ of the breast: Analysis of 270 consecutive patients treated in a 9-year period. Cancers (Basel) 2021;13(3):431.
McGinty EE, Zhang Y, Guallar E, Ford DE, Steinwachs D, Dixon LB, et al. Cancer incidence in a sample of Maryland residents with serious mental illness. Psychiatr Serv 2012;63(7):714–7.
Rahman T, Kaklamani V, Frische R. Manic and nonadherent, with a diagnosis of breast cancer. Curr Psychiatr 2016;15(1):51–7.
Tesli M, Athanasiu L, Mattingsdal M, Kähler AK, Gustafsson O, Andreassen BK, et al. Association analysis of PALB2 and BRCA2 in bipolar disorder and schizophrenia in a scandinavian case-control sample. Am J Med Genet B Neuropsychiatr Genet 2010;153B(7):1276–82.
Huang RY, Hsieh KP, Huang WW, Yang YH. Use of lithium and cancer risk in patients with bipolar disorder: population-based cohort study. Br J Psychiatry 2016;209(5):393–9.
Soomro R. Is breast cancer awareness campaign effective in Pakistan? J Pak Med Assoc 2017;67(7):1070–3.
Maffuz A, Barroso-Bravo S, Nájera I, Zarco G, Alvarado-Cabrero I, Rodríguez-Cuevas SA. Tumor size as predictor of microinvasion, invasion, and axillary metastasis in ductal carcinoma in situ. J Exp Clin Cancer Res 2006;25(2):223–7.
Elmaci İ, Altinoz MA. A metabolic inhibitory cocktail for grave cancers: metformin, pioglitazone and lithium combination in treatment of pancreatic cancer and glioblastoma multiforme. Biochem Genet 2016;54(5):573–618.
Maeng YS, Lee R, Lee B, Choi SI, Kim EK. Lithium inhibits tumor lymphangiogenesis and metastasis through the inhibition of TGFBIp expression in cancer cells. Sci Rep 2016;6:20739.
Li L, Song H, Zhong L, Yang R, Yang XQ, Jiang KL, et al. Lithium chloride promotes apoptosis in human leukemia NB4 cells by inhibiting glycogen synthase kinase-3 beta. Int J Med Sci 2015;12(10):805–10.
Kappes A, Vaccaro A, Kunnimalaiyaan M, Chen H. Lithium ions: a novel treatment for pheochromocytomas and paragangliomas. Surgery 2007;141(2):161–5.
Rouhani M, Goliaei B, Khodagholi F, Nikoofar A. Antimanic drug sensitizes breast cancer cell line to ionizing radiation. Gen Physiol Biophys 2014;33(2):235–42.
Zaidan M, Stucker F, Stengel B, Vasiliu V, Hummel A, Landais P, et al. Increased risk of solid renal tumors in lithium-treated patients. Kidney Int 2014;86(1):184–90.
Mo M, Erdelyi I, Szigeti-Buck K, Benbow JH, Ehrlich BE. Prevention of paclitaxel-induced peripheral neuropathy by lithium pretreatment. FASEB J 2012;26(11):4696–709.
Chang KH, Tan R, Chung CH. The use of lithium carbonate to correct leukopenia during cancer treatment. Zhonghua Yi Xue Za Zhi (Taipei) 1989;43(3):165–70