Eccrine syringofibroadenomatosis of the reactive subtype occurring in chronic poorly-controlled psoriasis.

Eccrine syringofibroadenomatosis (ESFA) is a rare adnexal tumor with acrosyringeal differentiation. Clinically, it can be mistaken for granulomatous infections or malignancies such as squamous cell carcinoma. Despite the rarity of the condition, we recently encountered two cases of the reactive subtype, which occurred in patients with poorly controlled chronic psoriasis. Both patients presented with long‑standing, thick verrucous lesions on the lower legs. The diagnosis was made after histological examination and exclusion of infectious and neoplastic disorders. As this is a reactive disorder, management is focused on treating the underlying condition. Unfortunately, psoriasis was difficult to manage in both our patients and they defaulted further treatment. It is important to recognize ESFA as it can be confused with infectious or malignant disorders.

Histopathological Study of Neoplastic Lesions of Breast.

Aims and Objectives: 1) To study the incidence of various neoplastic lesions of breast. 2) To study the histopathological features of neoplasms and classify them according to WHO classification (2003). 3) To compare the results of study with those of other studies. Materials and Methods: The present study was prospective as well as retrospective which include 252 cases from October 2005 to October 2010. The specimens were received in different forms such as excisional biopsies, modified radical mastectomies, simple mastectomies, tru-cut biopsies, wide local excision and quadrantectomy specimens. Detail gross examination was done for each specimen and histopathological features were studied to classify neoplasms according to WHO classification 2003. Results: Out of total 9086 biopsies, breast biopsies were 366 (4%) during this 5 year study. Total 252 breast neoplasms were studied, where, the incidence of benign neoplasms was 50.4% (127 cases) & for malignant neoplasms was 49.6% (125 cases). Among all types of specimen received, excision biopsy was most common (48%). Upper outer quadrant was most commonly involved region for breast neoplasms. Fibroadenoma, benign phyllodes neoplasm, tubular adenoma, central papilloma, peripheral papilloma, lipoma and neurofibroma were seen among benign neoplasms. While invasive ductal carcinoma not otherwise specified, mixed carcinoma, metaplastic carcinoma, mucinous carcinoma, malignant phyllodes neoplasm, invasive lobular carcinoma, invasive papillary carcinoma, medullary carcinoma, intracystic papillary carcinoma, malignant peripheral nerve sheath neoplasm and collision neoplasm were studied among malignant neoplasms. The most common benign neoplasm was fibroadenoma (87%) and invasive ductal carcinoma not otherwise specified (88%) was malignant neoplasm. Conclusions: Fibroadenoma was the most common (87%) benign breast neoplasm. Among all malignant breast neoplasms, invasive ductal carcinoma, not otherwise specified was most common (88%). In cases of benign neoplasms, the highest incidence was found in the age group of 10-20 years (37%) while in the malignant neoplasms, it was 40 - 60 years (51.2%). The incidence of malignant breast neoplasm in male was 2.4%.

Value of scoring system in classification of proliferative breast disease on fine needle aspiration cytology.

Fine-needle aspiration (FNA) cytology is successful in identification of benign and malignant breast lesions, but its role in proliferative breast lesions which increase cancer risk is poorly defined. We have analyzed the cytomorphologic features of proliferative breast lesions in conjunction with cytologic scoring system proposed by Masood et al and with histopathology. Sixty two patients (14 cases of fibroadenoma, 15 cases of fibroadenoma with atypia, 11 cases of proliferative breast disease (PBD), 8 cases of PBD with atypia and 14 cases of carcinoma) diagnosed on routine FNA were subjected to scoring following Masood's criteria. All cases with the cytologic diagnosis of fibroadenoma were confirmed on histology. Of 11 cases of PBD on FNA, 10 were PBD without atypia on histology. One case, which showed atypical hyperplasia on histology, was missed by both the scoring system and cytomorphology and one case was over-diagnosed as PBD with atypia by the scoring system. FNA cytology correctly identified all the carcinoma cases, while the scoring system under-diagnosed 2 cases as PBD with atypia. Hence, in cases not suspected to be atypical or confirmed to be cancer on routine cytology, scoring added no information over and above cytomorphology and was not useful. All fourteen cases of fibroadenoma with atypia suspected on routine cytology were fibroadenoma on histology. Scoring system correctly placed 11/14 of these cases as PBD without atypia. Similarly 3/8 cases thought to be PBD with atypia were correctly placed as PBD without atypia by scoring. Only 2/8 cases thought to be PBD with atypia on cytology were confirmed to have atypical hyperplasia on histology. Scoring improved the diagnostic yield to 2/5. Hence, in cases of fibroadenoma or PBD, suspected on FNAC to have cytological atypia, Masood scoring gives additional information by eliminating benign cases and improving diagnostic yield. Application of scoring in a step-wise manner, on atypical aspirates, can help in selection of cases suitable for biopsy.

Tumores benignos de la mama / Benign tumors of the breast

Los tumores benignos de la mama representan el 20 por ciento de las afecciones de la glándula y pueden desarrollarse sea a partir del tejido mamario específico, sea del estroma. De ellos el 70 por ciento corresponde a los fibroadenomas, el 10 por ciento a tumores papilares y el 9 por ciento a lipomas. Se analizan las características clínicas, semiológicas e histológicas de los principales tumores mamarios benignos, destacando entre ellos los fibroadenomas y los tumores papilares únicos y múltiples. Se mencionan también algunas lesiones poco freceuentes como la papilomatosis juvenil, el adenoma del pezón y el hamartoma. Se discute el valor de diversos porcedimientos actualmente disponibles en el estudio de los tumores benignos de la mama. Entre ellos destacan la mamografía, la ecotomografía, la biopsia con aguja fina y la citología por punción