Paget’s disease of the breast: clinical, imaging and pathologic findings: a review of 16 patients

Objectives: To determine the clinical, imaging and pathological findings of Paget’s disease of the breast. Materials and methods: Approval by Institutional Review Board was granted and informed consent was waived. Retrospective review of the pathological diagnosis of 2,361 women with breast carcinoma between January 2004 and April 2010 revealed 27 patients with Paget’s disease of the breast. The clinical, mammographic and ultrasonographic images were retrospectively reviewed. Results: The prevalence of Paget’s disease of the breast was 1.14% of all breast carcinoma at this institution. Of the 27 patients with Paget’s disease, only 16 had imaging studies and this group constituted the basis of this study. All 16 patients were women, with ages ranging from 36–68 years (mean age 50.31 years). Eleven patients presented with clinical findings suggestive of Paget’s disease of the breast. Seven of these 11 patients also had associated palpable mass(es). Four patients presented with a palpable mass alone and one presented with bloody nipple discharge alone. Mammography was performed in all 16 patients and ultrasonography (US) in 15 patients. Of the 16 mammographic studies, two were negative. Of the 15 US studies, three were negative. Of these three negative US studies, two also had negative mammography and one had pleomorphic microcalcifications on mammogram. US was helpful in detecting multifocality in two patients. Mammography was 100% positive in patients who presented with palpable breast mass(es) and bloody nipple discharge, but 50% positive in patients who had clinically suggestive Paget’s disease alone. Almost all patients (15/16) had underlying breast malignancies. Seven patients had multifocality or multicentricity. Modified radical mastectomy was performed in 13 patients, simple mastectomy in two, and wide local excision in one patient. Pathological findings were ductal carcinoma in situ (DCIS) (n = 3), invasive ductal carcinoma (IDC) (n = 10), metaplastic carcinoma (n = 1), invasive lobular carcinoma (ILC) (n = 1), and only Paget’s disease of the nipple without underlying breast carcinoma (n = 1). Conclusion: Patients with Paget’s disease of the breast have a high incidence of an underlying breast carcinoma. Most of the patients in this study presented late and were more likely to have positive mammograms. Mammography should be performed to identify the underlying breast carcinoma. Those who have only nipple areolar changes and no palpable mass have less positive mammography and less invasive carcinoma.

Primary intraosseous glomus tumor: a case report.

We reported a rare case of a primary intraosseous glomus tumor in a 53-year-old woman who had a small lytic lesion in the distal phalanx of her left index finger. The radiologic appearance showed a well circumscribed osteolytic lesion without sclerotic rim. Histologic examination revealed solid nests or sheets of polygonal cells surrounding branching vasculatures consistent with a glomus tumor. Curettage resulted in complete removal of the tumor as well as pain alleviation. The patient was well without evidence of recurrent disease following an 18 month follow-up. Despite its rarity, intraosseous glomus tumor should be included in the differential diagnosis of bone lesions in which plain radiography showed a well circumscribed punch-out lesion without sclerotic rim especially those arising in the finger.

Fine needle aspiration of the thyroid gland.

Fine needle aspiration (FNA) has become a major diagnostic triage for clinical management of patients with a thyroid mass. Diagnostic accuracy of this procedure can be evaluated by cyto-histologic correlation. Out of 1,761 fine needle aspirates of thyroid glands performed from January 1996 to December 1999, 230 satisfactory specimens contained respective histologic correlates. Using histologic diagnoses as the gold standard, the overall accuracy, sensitivity and specificity for cytologic diagnoses of thyroid neoplasm were 90.4 per cent, 85.7 per cent, and 92.5 per cent respectively. The positive predictive value for diagnosing thyroid neoplasm was 83.3 per cent while the negative predictive value was 93.7 per cent. The common pairs of cyto-histological diagnostic discrepancy included adenomatous goiter vs follicular neoplasm, adenomatous goiter vs papillary carcinoma, and thyroiditis vs follicular neoplasm. In conclusion, FNA is a rapid, reliable and safe diagnostic tool to distinguish non-neoplastic from neoplastic lesions in patients with thyroid masses.

Muscular hamartoma of the breast: a rare breast lesion containing smooth muscle.

Hamartoma of the breast is an uncommon entity, usually presenting as a well-demarcated breast mass. Microscopically, the lesion is composed of mammary glandular component, fibrous stroma, adipose tissue, and smooth muscle in variable proportions. Among the variants of breast hamartoma, muscular hamartoma is rare. This lesion should be differentiated from other breast tumors that contain smooth muscle element. We report a breast lesion of a 36-year-old woman diagnosed as a muscular hamartoma in which the muscular component is cellular and some mitotic figures are present. The criteria to distinguish between benign and malignant smooth muscle lesions in the breast, emphasizing mitotic count, are also discussed.

Immunohistochemical characterization of a new monoclonal antibody reactive with dengue virus-infected cells in frozen tissue using immunoperoxidase technique.

This paper presents a novel monoclonal antibody shown to react with cytoplasmic antigens in various dengue infected human frozen organs from autopsy and necropsy specimens. Strong reactivity was found in hematopoietic cells, including immunoblasts, lymphocytes, plasma cells and macrophages of spleen, lymph node, lung, kidney and stomach. Strikingly, strong positivity was demonstrated in cerebral cortex neurones, Purkinje cells, choroid plexus and blood vessels in addition to astrocytes and microglia. Neurotropism of the virus could explain the meningitis, encephalitis, mononeuropathy and polyneuropathy observed by direct toxicity, but noted especially after an activation of mononuclear phagocytes and amplification of the immune response with subsequent vascular inflammation and formation of immune complexes.

Bacillary angiomatosis and mycobacterium infection coexisting in a cutaneous lesion in a patient with AIDS.

Bacillary angiomatosis is a recently recognized bacterial infectious disease. It mainly affects patients with acquired immunodeficiency syndrome. The presence of coexistent infections of more than one pathologic process in skin lesions in patients with AIDS has been demonstrated. We report a patient with AIDS in whom both bacillary angiomatosis and mycobacterium infection were documented within the same cutaneous lesion.

Histopathologic spectrum of AIDS-associated lesions in Maharaj Nakorn Chiang Mai Hospital.

The histopathological alterations in various organs and the presence of AIDS-associated lesions were studied in 86 biopsy and 29 necropsy specimens of AIDS patients. The most common cancer seen in this study were malignant lymphomas (4% of cases) with development of extensive extranodal lymphomatous involvement from the outset. Although a preponderance of high grade B-cell pathologic subtypes is found in AIDS-associated lymphoma, we also report the first case of T-lymphoblastic lymphoma with a picture of acute lymphoblastic leukemia (T-ALL). Tuberculosis (34% of cases) was the most common opportunistic infection presented in tissue sections, and the majority of tissue biopsies revealed poorly organized granulomas and extensive necrosis with numerous bacilli. Penicilliosis (20% of cases) appeared to be the most common cutaneous lesion with multiple organ involvement. The involved organs showed a partially anergic tissue reaction characterized by poorly formed granulomas with diffuse infiltrate of fungi-laden macrophages and lymphoid cell depletion. This organism has to be distinguished from Histoplasma capsulatum and other yeast-form fungi. Co-existing cytomegalovirus and P. carinii infections were the predominant findings in lung necropsy specimens from pediatric patients who died from AIDS. A major pathologic feature in this group was diffuse alveolar damage stage II to III with heavy loads of organism and extensive lymphoplasmacytic infiltration.

Detection of estrogen and progesterone receptor bindings in mammary carcinoma cells: a comparative study using immunohistochemical and biochemical methods.

A comparative study of estrogen and progesterone receptor bindings of breast carcinoma tissue was done by immunoperoxidase and dextran-coated charcoal (DCC) methods. Fifteen cases of paraffin embedded formalin fixed tissue of mammary carcinomas which had previously been evaluated by the DCC method were selected. Twelve cases were ductal carcinoma and 3 were of lobular origin. Lymph node tissue showing metastasis was available in 3 cases. By immunoperoxidase technique, 12 and 10 (80 and 66.7%) cases were positive for estrogen and progesterone receptor respectively compared with 8 and 3 (53.3 and 20%) cases by the DCC technique. Corresponding results of both methods to detect estrogen and progesterone bindings were 9 and 8 (60 and 53.3%) of all cases, respectively. Five cases for estrogen and 6 cases for progesterone positive by immunoperoxidase could not be detected by the DCC technique. Only one case of estrogen negative by the immunoperoxidase gave a positive result with the DCC technique. Variability of staining occurred between primary and metastatic lesions, 2 out of 3 cases displayed positive staining in both sites; one remaining case was positive only in the lymph node metastasis. Immunoperoxidase is a relatively simple, swift and inexpensive technique in comparison to the DCC technique. Using fixed embedded tissue makes it possible for retrospective studies and providing a permanent record for reevaluation. Moreover, morphology of the tumor can be determined at the same time as detection of hormonal receptor bindings.