Mastitis linfocítica en la mujer joven. La importancia del diagnóstico histológico. Reporte de caso / Lymphocytic mastitis in young women. The importance of histological diagnosis. Case report

La mastitis linfocítica o mastitis diabética es una patología benigna rara, caracterizada por una inflamación fibrótica de la mama, causando gran preocupación por la simulación de un carcinoma. Está asociada por lo general a la diabetes tipo 2, aunque pueden presentarse en otras patologías autoinmunes y además en pacientes sin comorbilidades. Se presenta en caso clínico de una paciente joven sin comorbilidades que consulto en consultorio de patología mamaria por tumor mamario. Se realizó una biopsia percutánea por trucut con confirmación histológica de mastitis linfocítica, se realizó control cercano observándose remisión clínica e imagenológica de la lesión en 6 meses de seguimiento. Se presenta el caso a fin de recalcar la importancia del diagnóstico histológico percutáneo de la lesión para determinar la naturaliza de la misma, constatándose una patología benigna que no requiere resección, evitando así causar deformidades que podrían afectar psicológicamente a la paciente.

Lymphocytic mastitis or diabetic mastitis is a rare benign pathology, characterized by fibrotic inflammation of the breast, causing great concern due to the simulation of carcinoma. It is generally associated with type 2 diabetes, although it can occur in other autoimmune pathologies and also in patients without comorbidities. The clinical case of a young patient without comorbidities who consulted in the breast pathology clinic due to a breast tumor. A percutaneous trucut biopsy was performed with histological confirmation of lymphocytic mastitis, close control was performed, observing clinical and imaging remission of the lesion in 6 months of follow-up. The case is presented in order to emphasize the importance of percutaneous histological diagnosis of the lesion, to determine its nature, confirming a benign pathology that does not require resection, thus avoiding causing deformities that could psychologically affect the patient.

Caracterización clínico-patológica y manejo de pacientes con mastitis granulomatosa crónica en un centro de alta complejidad / Clinicopathological characterization and management of patients with chronic granulomatous mastitis in a high complexity center

Introducción. La mastitis granulomatosa crónica es una enfermedad inflamatoria poco frecuente y con mayor incidencia en el sexo femenino. Su sintomatología y su presentación clínica causan gran ansiedad tanto en el paciente como en el personal médico, debido a su comportamiento similar al de la patología mamaria maligna. No hay una etiología clara ni un manejo terapéutico definido. El objetivo de este estudio fue determinar las características clínico-patológicas, el tratamiento y la evolución de las pacientes con mastitis granulomatosa, durante el periodo de estudio. Métodos. Estudio retrospectivo en el que se revisaron las historias clínicas de pacientes con diagnóstico y manejo de trastorno inflamatorio de la mama no especificado (N61X), entre enero de 2010 y diciembre de 2019. Se encontraron 236 pacientes, se excluyeron 176 por no cumplir con el diagnóstico de mastitis granulomatosa crónica o por no tener un seguimiento adecuado. Se evaluaron las características sociodemográficas, clínicas y de evolución, comparando la respuesta que se obtuvo con cada tratamiento. Resultados. Se incluyeron 60 pacientes femeninas que presentaron manifestaciones variadas. El 38,3 % (n=23) recibieron manejo antibiótico, el 30 % (n=18) fue tratado con corticoides, el 8,3 % (n=5) recibió antibióticos más corticoides y se realizó manejo expectante en el 16,6 % (n=10). El 6,6 % (n=4) de los pacientes fueron llevados a cirugía. Discusión. La mejor respuesta y la menor tasa de recidiva se encontró en las pacientes que fueron sometidas a observación y en aquellas que recibieron corticoides

Introduction. Chronic granulomatous mastitis is a rare inflammatory disease with a higher incidence in females. Its symptoms and its clinical presentation cause great anxiety both in the patient and in the medical personnel, due to its behavior similar to that of malignant breast disease. There is no clear etiology or defined therapeutic management. The objective of this study was to determine the clinical-pathological characteristics, treatment and evolution of the patients with granulomatous mastitis, during the study period. Methods. Retrospective study in which the medical records of patients with diagnosis and management of unspecified inflammatory disorder of the breast (N61X) were reviewed, between January 2010 and December 2019. Two-hundred-thirty-six patients were found, 176 were excluded for not complying with the diagnosis of chronic granulomatous mastitis or for not having an adequate follow-up. The sociodemographic, clinical and evolution characteristics were evaluated, comparing the response obtained with each treatment. Results. Sixty female patients who presented varied manifestations were included, of which 38.3% (n=23) received antibiotic treatment, 30% (n=18) were treated with steroids, 8.3% (n=5) received antibiotics plus steroids, expectant management was performed in 16, 6% (n = 10), and 6.6% (n=4) of the patients were taken to surgery.Discussion. The best response and the lowest recurrence rate were found in patients who were observed and in those who received steroids

Metaplastic Carcinoma with Chondroid Differentiation Arising in Microglandular Adenosis

Microglandular adenosis (MGA) of the breast is a rare, benign proliferative lesion but with a significant rate of associated carcinoma. Herein, we report an unusual case of metaplastic carcinoma with chondroid differentiation associated with typical MGA. Histologically, MGA showed a direct transition to metaplastic carcinoma without an intervening atypical MGA or ductal carcinoma in situ component. The immunohistochemical profile of the metaplastic carcinoma was mostly similar to that of MGA. In both areas, all the epithelial cells were positive for S-100 protein, but negative for estrogen receptor, progesterone receptor, HER2/neu, and epidermal growth factor receptor. An increase in the Ki-67 and p53 labelling index was observed from MGA to invasive carcinoma. To the best of our knowledge, this is the first case of metaplastic carcinoma with chondroid differentiation arising in MGA in Korea. This case supports the hypothesis that a subset of MGA may be a non-obligate morphologic precursor of breast carcinoma, especially the triple-negative subtype.

Mammary Carcinoma Arising in Microglandular Adenosis: A Report of Five Cases

Mammary carcinoma arising in microglandular adenosis (MGA) is extremely rare, and MGA is regarded as a non-obligate precursor of triple-negative breast cancer. We report five cases of carcinoma arising in MGA of the breast. All cases showed a spectrum of proliferative lesions ranging from MGA to atypical MGA, ductal carcinoma in situ or invasive carcinoma. Immunohistochemically, all cases were triple-negative and expression of S-100 protein gradually decreased as the lesions progressed from MGA to atypical MGA and carcinoma. Three cases showed acinic cell differentiation with reactivity to α1-antitrypsin, and one case was metaplastic carcinoma. During clinical follow-up, one patient developed local recurrence. Carcinoma arising in MGA is a rare but distinct subset of triple-negative breast cancer with characteristic histologic and immunohistochemical findings.

Prerequisites for histopathological evaluation of reduction mammoplasty specimens: Recommendations based on an audit in a tertiary care hospital

Objective: To recommend prerequisites for the histo-pathological evaluation of reduction mammoplasty [RM] specimens based on an audit in a tertiary care hospital

Methods: All reduction mammoplasty specimens received at department of pathology, in a tertiary care hospital over a 3 years period were re-evaluated retrospectively. Medical records were checked for age, family history of breast cancer, indication for surgery and radiological evaluation. Pathology reports were reviewed for number of blocks sampled and diagnosis. A prerequisites protocol was developed based upon deficiencies and impediments noted

Results: We received a total of 26 cases of reduction mammoplasty. Only 2 [7.69%] specimens were from males. The age of the patients ranged from 26 to 50 years. Indication for surgery was provided in all [100%] of cases, with macromastia being most prevalent indication. Family history of breast carcinoma and radiological evidence was absent or not provided in all cases. The number of blocks prepared were in range of <4 in 17 [73.91%], 5-8 blocks in 5 [19.23%] and 8-12 blocks in 4 cases [15.38%]. The main histopathological finding was fibrocystic change, [n = 12, 46.15%]. Specimen radiography was not conducted in any case

Conclusion: There is a need to stratify RM cases as high, moderate and low risk of breast cancer based on family history of breast carcinoma, clinical and radiological evaluation. The high risk cases should be oriented, with margins inked and extensive sampling done. Specimen radiography should be carried out in younger patients in which mammography is not recommended

Galactocele medicamentosa pós-mamoplastia de aumento: relato de caso e revisão da literatura / Galactocele due to drugs prescribed after augmentation mammoplasty: a case report and literature review

A mamoplastia de aumento é um procedimento cirúrgico muito comum e seguro na cirurgia plástica, mas o mesmo não está isento de complicações. A galactocele após mamoplastia de aumento é raramente descrita na literatura. Este relato de caso refere-se a uma paciente de 34 anos de idade, que fazia uso de sulpirida há 2 anos e 4 meses e desenvolveu galactocele cerca de 100 dias após mamoplastia de aumento. O diagnóstico deve ser suspeitado quando se observar uma mama aumentada de volume, associada a calor local, dor ou desconforto mamário no pós-operatório. Acredita-se que a melhor conduta seja a drenagem cirúrgica, a fim de confirmar o diagnóstico de galactocele e excluir a presença de abscesso mamário.

Augmentation mammaplasty is a common and safe plastic surgery procedure, but it is not free from complications. Galactocele after augmentation mammaplasty is rarely described in the literature. We discuss the case of a 34-year-old woman who had been taking sulpiride for 2 years and 4 months and developed galactocele approximately 100 days after augmentation mammaplasty. However, diagnosis should be suspected if breast size increases and it is associated with postoperative local heat, pain or breast discomfort. We believe that the surgeon must surgically drain galactocele to confirm diagnosis, especially to exclude the presence of breast abscess.

Magnetic Resonance Imaging Features of Adenosis in the Breast / 한국유방암학회지

PURPOSE: Adenosis lesions of the breast, including sclerosing adenosis and adenosis tumors, are a group of benign proliferative disorders that may mimic the features of malignancy on imaging. In this study, we aim to describe the features of breast adenosis lesions with suspicious or borderline findings on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: In our database, we identified 49 pathologically proven breast adenosis lesions for which the final assessment of the breast MRI report was classified as either category 4 (n=45) or category 5 (n=4), according to the Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology (ACR). The lesions had a final diagnosis of either pure adenosis (n=33, 67.3%) or mixed adenosis associated with other benign pathologies (n=16, 32.7%). RESULTS: Of the 49 adenosis lesions detected on DCE-MRI, 32 (65.3%) appeared as enhancing masses, 16 (32.7%) as nonmass enhancements, and one (2.1%) as a tiny enhancing focus. Analysis of the enhancing masses based on the ACR BI-RADS lexicon revealed that among the mass descriptors, the most common features were irregular shape in 12 (37.5%), noncircumscribed margin in 20 (62.5%), heterogeneous internal pattern in 16 (50.0%), rapid initial enhancement in 32 (100.0%), and wash-out delayed en-hancement pattern in 21 (65.6%). Of the 16 nonmass enhancing lesions, the most common descriptors included focal distribution in seven (43.8%), segmental distribution in six (37.5%), clumped internal pattern in nine (56.3%), rapid initial enhancement in 16 (100.0%), and wash-out delayed enhancement pattern in eight (50.0%). CONCLUSION: Adenosis lesions of the breast may appear suspicious on breast MRI. Awareness of these suspi-cious-appearing features would be helpful in obviating unnecessary breast biopsies.

Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies?: A Pictorial Essay

Irregular hypoechoic masses in the breast do not always indicate malignancies. Many benign breast diseases present with irregular hypoechoic masses that can mimic carcinoma on ultrasonography. Some of these diseases such as inflammation and trauma-related breast lesions could be suspected from a patient's symptoms and personal history. Careful ultrasonographic examination and biopsy could help to differentiate these from malignancies.

Alterações funcionais benignas da mama / Benign functional alteration of the breast

A alteração funcional benigna da mama está intimamente relacionada à ansiedade e ao medo do câncer de mama. Acomete cerca de 70% das mulheres, 54% de mamas normais à autópsia, 34% de biópsias mamária e 40% de todos os cânceres de mama. Tem sido observada maior incidência nas pacientes de alto poder econômico. O diagnóstico é basicamente clínico e está relacionado à história de dor mamária pré-menstrual de caráter progressivo, ocupando todo o ciclo, além da presença de vários "nódulos". Ocorre na idade reprodutiva com pico entre mulheres de 30 a 40 anos. O quadro clínico passa obrigatoriamente por dor e nodularidade. O diagnóstico radiológico se restringe à mamografia e ao ultrassom sem alterações patológicas. A confirmação diagnóstica é dada pelo estudo anatomopatológico, através de punção aspirativa por agulha fina, trocarte e biópsia cirúrgica. A principal conduta terapêutica é afastar a causa oncológica como responsável pela mastalgia, portanto o exame físico das mamas, adicionado aos exames subsidiários, é obrigatório. Com a exclusão de processo neoplásico, 60% a 80% das pacientes têm remissão espontânea da dor. A presença de nodularidade deve ser tratada de acordo com o resultado anatomopatológico. A indicação de retirada da área somente ocorre na vigência de diagnóstico duvidoso ou suspeito e, até mesmo, nos casos de refratariedade ao tratamento clínico. O tratamento medicamentoso se baseia no emprego de várias drogas, tais como progesterona, antiprolactinas, agentes antigonadotropinas, medicamentos competidores com os receptores hormonais para estrogênio, uso de análogo de GnRH (goserelina), ácido gamalinoleico, restrição de metilxantinas, vitaminas E e A, complexo B, diuréticos e anti-inflamatórios...

A comunicação médico-paciente na percepção de mulheres com nódulo mamário e indicação de biópsia / Doctor-patient communication as perceived by women with a mammary nodule recommended for biopsy

Compreender como a comunicação com mastologistas é percebida e interpretada no diagnóstico de nódulo mamário com indicação de biópsia. Métodos: estudo qualitativo, com abordagem hermenêutica e crítica, efetuado em serviço de referência, em Recife, PE. Foram realizadas entrevistas semiestruturada com 16 mulheres entre 35-63 anos de idade. Formaram-se dois grupos de mulheres (Grupo 1 com e Grupo 2 sem hipótese diagnóstica de câncer). Resultados: nenhuma mulher relatou interesse do médico por sua percepção da doença. A relação com mastologistas foi satisfatória para o Grupo 1, sobretudo, pela sinceridade e atitude solidária ao facilitar o acesso a consultas e exames. No Grupo2 predominou a percepção de falta de reciprocidade. A comunicação médico-paciente sucedeu, principalmente, enquanto era necessária ao profissional, para apreender demandas reconhecidas cientificamente e fornecer informações, sendo mais demorada e esclarecedora com o Grupo 1. A banalização do nódulo benigno pelo médico resultou numa enorme insatisfação das mulheres do Grupo 2 quanto às informações obtidas, em particular, na definição do diagnóstico e conduta. Em geral, desconsiderou-se direito da paciente de opinar sobre suas conveniências. Conclusões: a comunicação médico-paciente teve caráter informativo e paternalista, com maior atenção dedicada às mulheres com suspeita de câncer. Nenhuma delas, ainda quando muito insatisfeitas, visaram de fato um projeto terapêutico individual. Dialogar é tarefa difícil para médicos e pacientes...

To understand how communication with mastologists is perceived and interpreted on diagnosis of a mammary nodule recommended for biopsy. Methods: a qualitative, hermeneutical and critical, study was carried out at a referral center in Recife, in the Brazilian State of Pernambuco. Semistructured interviews were conducted with 16 women aged between 35 and 63 years. Two groups of women were formed (Group 1 with a possible cancer diagnosis and Group 2 without). Results: no woman reported any interest on the part of the physician in her perception of the disease. The relation with the mastologists was satisfactory for Group 1, especially in terms of sincerity and solidarity in providing access to consults and examinations. In Group 2, the perception of a lack of reciprocity was predominant. Doctor-patient communication succeeded principally when there was a need for the health worker to meet scientifically recognized requirements and provide information, with more time being taken and more clarification given with Group 1. The trivialization of a benign nodule by the physician resulted in enormous dissatisfaction among women in Group 2 in terms of information obtained, in particular in the diagnosis and course of action to be taken. Generally speaking, the patient's right to express an opinion regarding their degree of comfort was disregarded. Conclusions: doctor-patient communication is informative and paternalistic in nature, with greater attention being given to women suspected to have cancer. None of them, even where very dissatisfied, aimed at an individual treatment project. Dialogue is difficult for doctors and patients...

Incorporating breast cancer screening program in the medical curriculum of Cebu Institute of Medicine

The objective of the study was to describe the incorporation of breast cancer screening program in the medical curriculum of a medical school and determine its feasibility in finding breast cancer.METHODS: From school year 2011 - 2012, a 3-hour module that assesses third year medical students' proficiency in clinical breast examination (CBE) was incorporated into the pre-clinical clerkship program at the Cebu Institute of Medicine. The students who have satisfactorily completed the module were invited to participate in the Breast Cancer Control Outreach Program (BCAcop). Pertinent data included: number of participating consultants and students,number of patients seen as well as their demographic and clinical profile, breast cancer cases found.RESULTS: Four BCAcop were conducted and 6 consultants supervised the medical students in the CBE modules and BCAcop. Seventy seven medical students passed the CBE module and participated in BCAcop. A total of 254 patients with age range of 8 to 80 (mean32 years) attended the lay forum while 246 patients (96.9%) consulted at the on-site breast clinic. Among those examined, 146 patients (59.3%) had essentially normal breasts. Fibrocystic change was the most frequent diagnosis with 49 patients (19.9%), followed by fibroadenoma with 34 patients (13.8%). Six patients (2.4%) were suspected to have breast cancer. Four patients (66.7%) proceeded to have a biopsy and were confirmed. Two patients availed of treatment.CONCLUSION: Incorporating breast cancer screening program in the medical school curriculum encourages medical students to participate in breast cancer control outreaches where their basic knowledge and skills on clinical breast exam are reinforced with actual patient contact. Furthermore, women with breast cancer are found and offered treatment through this program.

Mastopatia Diabética: una entidad infrecuente a diferenciar / Diabetic mastitis: an uncommon entity differentiate

Introducción: La Diabetes mellitus produce microvasculitis y alteración histoarquitectural de la mama. Se encuentra en el 1% de la mastopatía benigna. Sin embargo, la distorsión delparénquima produce sintomatología inflamatoria clínicamente similar a las mastopatías inflamatorias infecciosas. Su diagnóstico imagenológico, es a su vez, de gran dificultad interpretativa. Estos parámetros inespecíficos, desembocan a tratamientos que no logran eficacia en la enfermedad, más aún si se ignora el contexto de la enfermedad de origen, la cual essistémica. Objetivos: destacar la importancia del diagnóstico diferencial de esta infrecuente entidad patológica. Material y Métodos: se revisaron historias clínicas de un servicio de mastología por el término de seis meses, a efectos de recabar información estadística. Resultados: histológicamente, estas pacientes presentaron rasgos microscópicos que consisten en una lobulitis linfocitaria que afecta al epitelio y gran vasculitis edematosa. El diagnóstico histológico es crucial para llegar al tratamiento. Conclusiones: la mastopatía de las pacientes diabéticas insulinodependientes es la manifestación crónica de eventos sistémicos, producido en un porcentaje muy bajo de pacientes con la enfermedad. La correcta interpretación clínica y mamográfica, además de la sospecha semiológica desembocanen el adecuado tratamiento de esta enfermedad, inserta en un contexto sistémico.

Introduction: Diabetes mellitus occurs histoarquitectural microvasculitis and alteration of the breast. It is found in 1% of benign breast disease . However, distortion occurs parenchymal inflammatory symptoms clinically similar to infectious inflammatory breast disease. Its diagnostic imaging , is in turn highly interpretive difficulty. These non specific parameters lead to effective treatments that fail in the disease , especially if the context of disease origin is unknown, which is systemic. Objectives: To highlight the importance of the differential diagnosis of this rare disease entity. Material and Methods : Clinical histories mastology service for a period of six months for the purpose of collecting statistical data were reviewed.Results: Histologically , these patients had microscopic features consisting lobulitis lymphocytic affecting large edematous epithelium and vasculitis. Histological diagnosis is crucial to get the treatment. Conclusions: Diabetic mastopathy in insulin dependent patients is chronic manifestation of systemic events , produced in a very low percentage of patients with the disease. The correct clinical and mammographic interpretation, in addition to lead to suspicion semiológica proper treatment of this disease, inserted in a systemic context.

Clinicopathologic features of cystic hypersecretory lesion of the breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunophenotype and differential diagnosis of cystic hypersecretory lesion (CHL) of the breast.</p><p><b>METHODS</b>Clinicopathologic and follow-up data of six cases of breast CHL in 2010-2013 were collected and reviewed.Immunohistochemical and mucinous staining was performed.</p><p><b>RESULTS</b>All six patients were female, age ranged from 37 to 71 years (average 49.3 years). Three cases were cystic hypersecretory hyperplasia (CHH), the other three cases were cystic hypersecretory carcinoma (CHC). Clinically the lesions presented as either breast mass or mammographic calcification.Grossly, the cystic hypersecretory lesions were poorly circumscribed, with multiple colloid containing cysts on the cut surface. Microscopically, the remarkable feature was numerous enlarged cysts which contained densely eosinophilic homogeneous secretion similar to the colloid seen in thyroid follicles, and calcification was seen in the cyst in one case. The secretion was D-PAS and mucicarmine positive. The lining epithelium of the cysts was uniformly flat, cuboid or columnar, and arranged in a monolayer. The cells may be arranged in turfs, solid or micropapillary patterns in CHH.In cases with dysplasia, the epithelium showed cytological and structural atypia, but the usual morphology of atypical dutal hyperplasia such as arcades, rigid bridges or cribriform pattern was less common. The three CHC included two invasive ductal carcinomas (IDC) and one ductal carcinoma in situ (DCIS).In CHL, there was immunoreactivity to S-100 protein, CK5/6 and CK14.Of the three CHCs, ER and PR were expressed in only one IDC.No HER2 expression was identified in the two invasive CHCs.One patient was lost to follow-up, and the rest were uneventful at 18 months.</p><p><b>CONCLUSIONS</b>CHL of the breast is a rare pathological entity. Multiple colloid-filled cysts is a unique histological feature. The epithelium of CHL may show usual hyperplasia, dysplasia or carcinoma.</p>

Meta analysis of efficacy and safety between mammotome minimally invasive operation and open excision for benign breast tumor / 中南大学学报(医学版)

OBJECTIVE@#To compare the efficacy and safety between mammotome minimally invasive operation and conventional open excision for benign breast tumor.@*METHODS@#A computer-based online search of Medline, PubMed, Embase, Ovid, Cochrane Library, VIP, Wanfang, CNKI and Chinese Biological Medicine Database was performed, and conference references were manually searched. With the Cochrane Collaboration Guidelines, all randomized controlled trials comparing mammotome minimally invasive operation and conventional open excision were systematically reviewed. The Cochrane Collaboration's RevMan 5.0 software was used for data analysis.@*RESULTS@#A total of 15 studies involving 5256 patients was included. Meta-analyses showed no significant difference in the size of tumor, postoperative hematomas, ecchymosis, ecchymoma and residual disease between mammotome minimally invasive operation and conventional open excision. Mammotome minimally invasive operation was superior to open excision as to the size of incision, intraoperative blood loss, surgical duration, healing time, size of scar, wound infection and breast deformation.@*CONCLUSION@#Mammotome minimally invasive surgery is an ideal method for benign breast tumor.

El ultrasonido como método diagnóstico de patología mamaria oculta en mujeres con mama densa: serie clínica / Ultrasound as a Diagnostic Method of Hidden Breast Pathology in Women with Dense Breasts (case series)

Objetivo: Determinar la importancia y utilidad del ultrasonido mamario como método de imagen complementario en pacientes con mamas densas, ACR 3 y 4. Materiales y métodos: Estudio observacional longitudinal de tipo prospectivo. Se evaluaron 483 pacientes femeninas que asistieron a la Clínica de Mamas (San Cristóbal, Estado Táchira) durante el periodo de febrero de 2010 a febrero de 2011 con mamas densas en mamografía, sin hallazgo clínico ni radiológico, con evaluación ultrasonográfica complementaria y posterior estudio histopatológico según grado de sospecha de lesión por categorización BI-RADS. Resultados: La edad promedio de las pacientes fue de 45,15 años, menarquía a los 12,57 años y mamas densas ACR 3, la mayoría sin antecedentes de cáncer de mama ni uso de terapia de reemplazo hormonal. Se diagnosticaron 304 lesiones ocultas, el 10,8% con características ultrasonográficas de sospecha y el 2,2% con hallazgos histopatológicos de malignidad. Conclusiones: Se demuestra la importancia del ultrasonido como método complementario de rastreo en pacientes con mama densa.

Objective: To determine the importance and usefulness of breast ultrasounds as supplementary imaging method in patients with dense breasts, ACR 3 and 4. Materials and methods: Prospective observational longitudinal type study. We evaluated 483 female patients in the Clínica de Mama (San Cristobal, Tachira Ste.) from February 2010 to February 2011 with dense breasts in mammography without clinical or radiological findings, with additional ultrasonographic evaluation and a histopathological study according to the degree of lesion suspicion by BIRADS categorization. Results: The average age of the patients was 45.15 years, The menarche age was 12.57 years and ACR 3 breasts. Most patients did not have a background of breast cancer, nor did they use hormone replacement therapy. 304 hidden lesions were diagnosed, 10.8% with suspicious ultrasonographic features and 2.2% with histopathological malignancy findings. Conclusions: The importance of the ultrasound as a complementary screening method is proven in patients with dense breasts.

Distribution of myofibroblast cells and microvessels around invasive ductal carcinoma of the breast and comparing with the adjacent range of their normal-to-DCIS zones

This study seeks to determine the relationships between manifestation of myofibroblast in the stroma tissue of hyperplastic pre-invasive breast lesions to invasive cancer by investigating clinicopathological data of patients, their effect on steroid receptor expression and HER2, and angiogenesis according to CD34 antigen expression. Handred cases of invasive ductal carcinoma were immunohistochemically investigated for the presence of smooth muscle actin [SMA], ER/PR, HER2, anti-CD34 antibody and microvessel count [MVC]. Patients were scored in four different zones of invasive areas: invasive cancer, DCIS, fibrocystic disease +/- ductal intraepithelial neoplasia [FCD +/- DIN], and normal tissue. There was a significant difference in stromal myofibroblast between all areas except for the stroma of DCIS and FCD +/- DIN [P < 0.001]. We observed positive significant correlations between stromal myofibroblast, HER2 expression, and the numbers of involved lymph nodes in invasive cancer, DCIS, and FCD +/- DIN [P < 0.001]. More myofibroblast were present in grade III cases, with the least frequent observed among grade I cases in the stroma of those with invasive disease, DCIS, and FCD +/- DIN [P < 0.001]. MVC was inversely related to stromal myofibroblast in invasive cancer [P < 0.001] and DCIS [P < 0.001], whereas there was a positive correlation in the stroma of FCD +/- DIN [P = 0.002] and normal areas [P = 0.054]. There was a significant difference in MVC observed in all areas except for DCIS and FCD +/- DIN [P < 0.001]. We noted significant inverse correlations between MVC, HER2 expression, and the numbers of involved lymph nodes in invasive cancer and DCIS [P < 0.001]. Most MVC were present in grade I, with the least frequent observed in grade III cases in the stroma of invasive cancer, DCIS and FCD +/- DIN [P < 0.001]. Angiogenesis can be observed before any significant myofibroblastic changes in the pre-invasive breast lesions. The elevated content of myofibroblast in stroma of tumor; probably may be a worse prognostic factor and the steps from atypical epithelial hyperplasia to DCIS and then to the invasive carcinoma do not appear to be always part of a linear progression

Invasive Breast Carcinoma Arising in Microglandular Adenosis: Two Case Reports / 한국유방암학회지

Microglandular adenosis (MGA) is a rare benign disease that shows an infiltrative growth pattern of small glands, and it may progress to include atypia and carcinoma. Here we report two cases of breast carcinoma arising in MGA. Case 1 was a 44-year-old woman with a previous history of ductal carcinoma in situ in her right breast. During a follow-up, a 1.8 cm mass-like lesion was found in her left breast. An excisional biopsy suggested that the lesion was breast carcinoma. Case 2 was a 57-year-old woman with a 2.9 cm mass in her right breast. A core needle biopsy of the lesion suggested invasive carcinoma. Both patients underwent modified radical mastectomy with sentinel lymph node biopsy. Both tumors lacked a myoepithelial cell layer and stained positively for S-100, lysozyme, and alpha1-antitrypsin, which is typical of MGA. Both cases showed invasive carcinoma arising in MGA.

Expression of fatty acid synthase and its association with HER2 in invasive ductal carcinoma of breast / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the expression of fatty acid synthase (FAS) in adenosis, atypical ductal epithelial hyperplasia, ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) of breast, and the correlation of FAS expression with HER2 gene amplification in IDC.</p><p><b>METHODS</b>Immunohistochemical EnVision method staining for FAS was performed in 100 cases of breast lesions and 10 normal breast tissues. HER2 gene amplification was detected with FISH in 60 cases of IDC.</p><p><b>RESULTS</b>The cohort included 10 cases of adenosis, 10 atypical ductal epithelial hyperplasia, 20 DCIS (8 high-grade, 9 intermediated-grade and 3 low-grade), and 60 cases of IDC (5 grade 1, 40 grade 2 and 15 grade 3). FAS expression was negative in all 10 normal breast tissues; in the 10 cases of adenosis, strongly positive FAS expression was detected in one case, positive in 2, weakly positive in 4, and negative in 3; in the 10 cases of atypical ductal epithelial hyperplasia, FAS immunohistochemistry showed that 1 was strongly positive, 4 positive, 4 weakly positive, and 1 negative; in the 20 cases of DCIS, FAS immunostaining showed that 12 were strongly positive, 5 positive, 1 weakly positive, and 2 negative; FAS expression showed a clear increasing trend from normal breast tissue, atypical ductal epithelial hyperplasia to DCIS (χ(2) = 42.02, P < 0.01). Likewise, the increasing trend was also demonstrated from adenosis to DCIS (χ(2) = 34.69, P < 0.01). There was also a positive correlation between FAS expression and extent of lesion among normal breast tissue, adenosis, atypical ductal epithelial hyperplasia and DCIS (χ(2) = 86.02, P < 0.01; r = 0.568, P < 0.01). FAS expression was not correlated with the grade of DCIS (χ(2) = 9.12, P = 0.16). In the five cases of grade 1 IDC, FAS immunostaining showed that 4 cases were strongly positive and 1 positive; in the 40 cases of grade 2 IDC, FAS immunostaining showed that 27 strongly positive, 12 positive, and 1 negative; in the 15 cases of grade 3 IDC, FAS immunostaining showed that 6 were strongly positive, 5 positive, 3 weakly positive, and 1 negative; FAS expression was stronger and more extensive in DCIS, IDC grades 1 and 2 than that in other groups. However, FAS expression was weaker in the IDC grade 3 (χ(2) = 11.26, P = 0.01). The positive expression rate of FAS in IDC was generally higher than that in benign breast lesions (χ(2) = 47.19, P < 0.01). In the 60 cases of IDC, FISH showed HER2 gene amplification in 22 cases, but not in the remaining 38 cases. FAS expression in IDC was highly correlated with HER2 gene amplification (r = 0.44, P < 0.01). The expression of FAS had significant correlation with status of ER and PR and tumor size (P < 0.05). There was no significant correlation with age, immunohistochemical HER2 expression, lymph node metastasis and clinical stage (P > 0.05).</p><p><b>CONCLUSIONS</b>FAS may be closely related to the carcinogenesis of breast IDC. FAS expression is closely associated with HER2 gene amplification in IDC.</p>