Invasive cystic hypersecretory carcinoma of the breast

ABSTRACT Cystic hypersecretory carcinoma (CHC) of the breast is a rare variant of ductal carcinoma, characterized by variably sized cysts lined by micropapillary fronds to proliferative pseudostratified columnar epithelium. It includes a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia to invasive CHC. Only 20 cases of invasive CHC have been reported to date. We report a case of a 49-year-old female who presented with a palpable breast lump and nipple discharge. Gross examination showed variable-sized cysts lined by solid grey white tumors. On microscopic examination, cysts were lined by micropapillary fronds with eosinophilic colloid-like secretion with a focus of invasion. A diagnosis of invasive CHC was made. Since there are limited case reports, our understanding of its biological behavior, prognostic factors, and genetic basis is limited.

Complex Fibroadenoma: a Cystic Neoplasia Report Case / Fibroadenoma Complexo: Relato de Caso de uma Neoplasia Cística

Abstract Fibroadenoma is the most common breast tumor in young woman. It is considered a non-malignant tumor, showing hyaline component and a biphasic stroma and epithelial process, thus, it is similar to phyllode tumor revealing intralobular stroma. The cystic changes in a complex fibroadenoma may mimic a carcinoma, therefore it may represent some problems in images interpretation, and it may enlarge the risk of cancer development. This is a description of a case report with literature review. A 21-year-old female patientwith no history of breast cancer in family, presented a palpable lump in her right breast and clinical examination revealed a mobile, firm, circumscribed lesion in the right inner quadrant, measuring around 8 x 7 cm. An excision had been done under a stereotactic surgery and the structure revealed a nodular surface, measuring 8 x 6.5x 5.5cm. Cut section revealed heterogeneous aspect: cysts with colloid content and white-gray compact fibroblastic areas. Histopathological examination shows hypocellular stroma and few hypercellular areas, without atypia. Epithelial components presenting proliferation of intracanalicular and pericanalicular pattern ducts. Cystic proliferation with epithelial lining and apocrine characteristics without atypia. Because of the variation may be present inside the lesion it is difficult to establish the diagnosis without a biopsy, and a histopathological analysis. Moreover, it is necessary to know the microscope difference between fibroadenoma and the other sort of lesions; furthermore, that heterogeneity represent why that tumor is considered complex. (AU)

Resumo Fibroadenoma é o tumor de mama mais comum em mulheres jovens. É considerado um tumor não-maligno, apresentando um componente hialino e um estroma bifásico, e processo epitelial, por isso, é similar ao tumor filoide, revelando estroma intralobular. As alterações císticas no fibroadenoma complexo pode mimetizar um carcinoma, isso acarreta alguns problemas na interpretação das imagens, e pode aumentar o risco de desenvolvimento de câncer. Trata-se de um relato de caso de paciente de 21 anos de idade, sem histórico de câncer de mama na família, apresenta uma massa palpável em seio direito. Exame clinico revelou lesão móvel, firme, circunscrita no quadrante interno do seio. Excisão por cirurgia estereotáctica e a estrutura se mostra com superfície multinodular, medindo 8 x 6,5 x 5,5 cm. com aspecto heterogêneo, cistos com conteúdo coloide, e áreas fibrobásticas branco-acinzentada. Exame histológico demonstra-se estroma hipercelular, com áreas hipocelularizadas, sem atipia. Componentes epiteliais apresentando proliferação intercanalicular e intracanicular dos ductos. Proliferação cística com revestimento epitelial e características apócrinas sem atipia. Por conta da variação presente na lesão, pode ser difícil a estabelecimento de um diagnóstico se biópsia e análise histopatológica. Além disso, é fundamental o conhecimento das diferenças microscópicas entre o fibroadenoma e outros tipos de lesões; além disso, a heterogeneidade representa o motivo do tumor ser considerado complexo. (AU)

Birads 3: correlacion histopatologica de bajo potencial de malignidad, con conglomerados quisticos imagenologicos en pacientes de tegucigalpa / Birads 3: correlation of low histopathological potential for malignancy with breast clustered microcysts in patients from tegucigalpa

La categoría 3 del Breast Imaging Reporting and Data System (BIRADS) son hallazgos probablemente benignos y en menos del 2% de estos existe la posibilidad de carcinoma. El establecimiento de esta categoría precisa la realización de pruebas complementarias de imagen que incluye: proyecciones mamográficas adicionales, la ecografía, comparar las imágenes actuales con los estudios previos de la paciente y en casos especiales se recurre a la biopsia. Dentro de esta categoría se incluyen los conglomerados quísticos en los que se centró este estudio. Objetivo: Correlacionar hallazgos ecográficos y mamográficos, con estudio histopatológico de lesiones categorizadas como conglomerados quísticos (en imagenología). Población y Métodos: Pacientes que acuden al Hospital de Especialidades del Instituto Hondureño de Seguridad Social a quienes se les realizó mamografía y ecografía categorizadas como BIRADS 3 a las cuales se les confirmó diagnóstico mediante biopsia. Resultados: De las pacientes categorizadas BI-RADS 3, a 55(100%) se les realizó biopsia, el reporte histopatológico corroboró patología benigna en 55(100%) y no se encontró patología maligna. Discusión: Los conglomerados quísticos de mama son relativamente comunes, observados en ecografía en el 5,8% de los casos, ecográficamente, se observa un nódulo circunscrito, microlobulado u oval, compuesto de múltiples quistes pequeños adyacentes separados por tabiques delgados. Se encuentra generalmente como hallazgo incidental en mamografía, ecografía o en ambos.

Category 3 of the Breast Imaging Reporting and Data System (BIRADS) are probably benign findings and in less than 2% of these there is the possibility of carcinoma. The establishment of this category requires the performance of complementary imaging tests that include: additional mammographic projections, ultrasound, compare current images with previous studies of the patient and in special cases, biopsy is used. This category includes the cystic conglomerates that this study focused on. Objective: To correlate ultrasound and mammographic findings, with histopathological study of lesions categorized as cystic conglomerates (in imaging). Population and Methods: Patients who attend the Specialties Hospital of the Honduran Social Security Institute, who underwent mammography and ultrasound categorized as BIRADS 3, which were confirmed by biopsy. Results: Of the patients categorized BI-RADS 3, to 55 (100%) a biopsy was performed, the histopathological report corroborated benign pathology in 55 (100%) and no malignant pathology was found. Discussion: The breast cystic conglomerates are relatively common, observed in ultrasound in 5.8% of cases, ultrasound, we can observe a circumscribed, microlobulated or oval nodule, composed of multiple small adjacent cysts separated by thin septa. It is usually found as an incidental finding on mammography, ultrasound or both.

Application of Ultrasound Guided Drainage Combined with Different Hardeners for Treatment of Simple Breast Cysts / 中国医学影像学杂志

Purpose To investigate the clinical effect of ultrasound guided drainage combined with different hardeners for simple breast cysts,and to further provide reference for individual treatment.Materials and Methods Clinical data of 117 cases breast simple cysts were analyzed retrospectively,of which 42 cases were routine ultrasound-guided puncture combined with fluid injection of hypertonic sugar (group A),40 cases were routine ultrasound guided drainage combined with ethanol injection therapy (group B),and 35 cases were routine ultrasound guided therapy alone (control group).The clinical efficacy and adverse reactions were compared among the three groups after treatment.Results The total effective rate of group A was 95.24％,group B was 97.50％,and control group was 82.86％.Total effective rate of group A and B had no significant difference (P＞0.05),which were both higher than control group (P＜0.05).The adverse reactions rate of group B was higher than group A and control group,which had statistical significance (P＜0.05).Conclusion Ultrasound guided injection of hypertonic sugar or ethanol after drainage treatment for simple breast cysts can both obtain satisfactory clinical results,but adverse reactions of the former one are mild,it should be widely applied.

The importance of breast elastography added to the BI-RADS® (5th edition) lexicon classification / A importância da elastografia mamária adicionada à classificação, segundo o léxico BI-RADS® (5ª edição)

SummaryObjective:the aim of this study was to investigate the addition of elastography to the BI-RADS® lexicon for the classification of breast lesions.Methods:a total of 955 consecutive patients who were subjected to breast percutaneous biopsy from January 2010 to December 2012 were retrospectively assessed. Overall, 26 patients who did not present with masses on conventional ultrasound were excluded. The patients were classified according to the fifth edition of the breast imaging and reporting data system (BI-RADS®) lexicon, which includes elastographic findings. The BI-RADS®classification is based on the same classification principles that have been suggested by the author, which classify lesions as soft, intermediate, or hard.Results:the addition of elastographic findings to the BI-RADS® lexicon improved the sensitivity (S), specificity (SP), and diagnostic accuracy (DA) of ultrasound in the assessment of breast lesions, which increased from 93.85, 72.07, and 76.64 to 95.90, 80.65, and 91.39%, respectively.Conclusion:these findings suggest that the addition of elastography to the BIRADS ® lexicon will improve the SP and DA of ultrasound in the screening of breast lesions.

ResumoObjetivo:investigar o impacto da adição da descoberta da elastografia das lesões mamárias à classificação segundo o léxico BI-RADS®.Métodos:estudo retrospectivo com 955 pacientes consecutivas, submetidas à biópsia mamária percutânea no período de janeiro de 2010 a dezembro de 2012. Foram excluídas 26 pacientes que apresentaram lesão não nodular ao ultrassom convencional. As lesões foram classificadas conforme proposta da 5ª edição do léxico BI-RADS®, que inclui os achados de elastografia. A classificação BI- -RADS® é baseada nos mesmos critérios propostos pelo autor, que classifica as lesões como macias, intermediárias e rígidas.Resultados:a adição dos achados da elastografia ao léxico BI-RADS® melhorou a sensibilidade (S), a especificidade (E) e a acurácia diagnóstica (AD) do ultrassom na avaliação das lesões mamárias, de 93.85, 72.07 e 76.64% para 95.90, 80.65 e 91.39%, respectivamente.Conclusão:os achados sugerem que a adição dos achados da elastografia ao léxico BI-RADS® pode melhorar a S, a E e a AD do ultrassom no rastreamento de lesões mamárias.

Quiste gigante de mama. Presentación de un caso / Giant Breast Cyst. A Case Report

El cáncer mamario en la mujer se encuentra dentro de las tres primeras causas de muerte en el mundo y en nuestro país ocupa, en las últimas estadísticas, el primer lugar. Se presenta el caso de una mujer de 94 años de edad, que falleció en el Hospital General Universitario Dr. Gustavo Aldereguia Lima, de Cienfuegos, con el diagnóstico de neoplasia maligna de mama con metástasis, cuya necropsia fue realizada el día 7 de noviembre del 2009 y en la que se constató la presencia de quiste gigante benigno, a partir de lo cual se elaboró el presente informe.

Breast cancer in women is among the top three causes of death in the world and in our country it is, according to the latest statistics, in the first place. We report the case of a woman aged 94, who died at the Dr. Gustavo Aldereguia Lima General University Hospital of Cienfuegos, with a diagnosis of breast malignancy with metastases. The autopsy, was conducted on November 7, 2009 and it confirmed the presence of giant benign cyst, from which this report was prepared.

Apresentação das lesões mamárias císticas à ultra-sonografia utilizando a elastografia / Features of cystic breast lesions at ultrasound elastography

OBJETIVO: Demonstrar a apresentação mais freqüente das lesões mamárias císticas utilizando a elastografia e discutir a sua aplicabilidade. MATERIAIS E MÉTODOS: A casuística compôs-se de 150 pacientes encaminhadas para realização de biópsia mamária percutânea com 175 lesões. Foram excluídas as lesões com diagnóstico histológico de lesões sólidas (153 lesões) e incluídas as lesões com características císticas à histologia (22 lesões), incluindo cistos complicados, lesões papilíferas, lesões inflamatórias, hiperplasia de células colunares típica e ectasia ductal. Estas lesões foram classificadas de forma retrospectiva por meio da elastografia, conforme escores criados pelos autores, variando de 1 a 4. RESULTADOS: Das 22 lesões encaminhadas, 13 (59 por cento) correspondiam a cistos, uma (4,6 por cento) a ectasia ductal, duas (9,2 por cento) a lesões inflamatórias, cinco (22,6 por cento) a lesões papilíferas e uma (4,6 por cento) a hiperplasia de células colunares. Foram encontrados 17 escores 2, quatro escores 3, um escore 4 e nenhum escore 1, com especificidade de 95 por cento. CONCLUSÃO: As lesões císticas mamárias têm diferentes apresentações à elastografia, conforme o resultado histológico, sendo este um método útil para a sua diferenciação e de fácil aplicabilidade na clínica diária.

OBJECTIVE: To demonstrate the most frequent features of cystic breast lesions at ultrasound elastography, discussing the applicability of this method. MATERIALS AND METHODS: The present casuistic included 150 patients referred for percutaneous breast biopsy of 175 lesions. Histologically diagnosed solid lesions (153 lesions) were excluded; lesions histologically diagnosed as cystic (22 lesions), including complicated cysts, papillary lesions, inflammatory lesions, typical columnar cell hyperplasia and duct ectasia were retrospectively classified by means of elastography, according to a scoring system developed by the authors, with categories ranging between 1 and 4. RESULTS: Thirteen (59 percent) of the 22 lesions evaluated corresponded to cysts, one (4.6 percent) to duct ectasia, two (9.2 percent) to inflammatory lesions, five (22.6 percent) to papillary lesions, and one (4.6 percent) to columnar cell hyperplasia. The scoring system was applied with the following results: 17 category 2 lesions, four category 3 lesions, one category 4 lesion, and none category 1 lesion, with a 95 percent specificity. CONCLUSION: Different features of cystic breast lesions are demonstrated by elastography according to histological results, representing a useful and easily applicable method for differentiating benign from malignant breast lesions.

Two Unusual Complications of Ventriculoperitoneal Shunts

The authors report two unusual complications of ventriculoperitoneal(VP) shunt, fractured ventricular catheter and the development of a huge cyst in breast. One patient, a 2-year-old male with a history of VP shunt operation due to bacterial meningitis two years ago, presented with a drowsy consciousness and gait disturbance after trivial head injury. When shaving the scalp for the shunt revision, small dimpling site which corresponded with the head injury site, was found. On the operative field, the ventricular catheter was found to be fractured at the valve connector. The other patient, a 24-year-old female who had undergone VP shunt due to tuberculous meningitis 2 months after a laparotomy 3 years ago, presented with a progressive enlargement of the right breast 2 months prior to admission. Radiologically, the breast appeared as a cystic mass containing the shunt catheter tip. The patient underwent ventriculoatrial shunt due to the repeated extraperitoneal migration of peritoneal catheter which resulted from the intraperitoneal adhesion. Not only an intense intraperitoneal adhesion but also trivial head injury may have caused the shunt failure. Precise history taking and physical examination are important to detect the cause of shunt failure. The possible mechanisms of the shunt failures are discussed.