Fine-needle aspiration of breast masses. A review of its role in diagnosis and management in adolescent patients.

PURPOSE: To assess the role of fine-needle aspiration biopsy (FNA) in the evaluation and management of breast masses in adolescents. METHODS: All FNAs performed on organ masses over a 15-year period on patients age 21 years and younger were evaluated. Cases were collected from four large university-affiliated teaching hospitals and clinics. Pathology records from the laboratory information systems were reviewed. Data included clinical information, anatomic site, and cytologic diagnoses. Surgical follow-up was included when available. RESULTS: Three hundred and twenty-five FNAs from 302 patients were reviewed. Of 325 aspirates, 59 were breast FNAs (in 51 patients: 4 males and 47 females). Among all organs, the breast was the most common one aspirated in females. Of the breast aspirates in females, 49% were diagnosed as fibroadenomas. No cases of malignant breast disease or phyllodes tumors were encountered. Surgical biopsy follow-up was available in 23.7% of the patients. Of those masses which were subsequently surgically biopsied, most were diagnosed as either fibroadenoma (11) or juvenile fibroadenoma (two). One other case biopsied showed ductal hyperplasia and adenosis. The majority of the remaining cases were followed up clinically, since the clinical nature and cytologic features of the lesions were those of fibrocystic changes or benign cysts. CONCLUSIONS: In the series of FNAs we examined, breast masses were the most frequent lesions aspirated in adolescent females, with fibroadenomas being the most common lesion encountered. FNA proved to be a useful and reliable tool in the evaluation and management of masses involving the adolescent breast. The majority of breast masses in adolescents are benign, and lesions can be managed conservatively in this age group. The use of noninvasive diagnostic procedures such as FNA and ultrasound can reduce the need for open surgery during breast development.

p53 and MDM2 immunostaining in pulmonary blastomas and bronchogenic carcinomas.

Pulmonary blastomas (PBs) are rare primary malignancies that include adult types: biphasic pulmonary blastoma (BPB) and well-differentiated fetal adenocarcinoma (WDFA); and childhood type: pleuropulmonary blastoma (PPB). Their pathogenesis and relationship to bronchogenic carcinoma (BCA) are controversial. To determine whether or not PB share molecular pathological features with BCA, the authors immunostained three BPB, three WDFA, three PPB, and 80 standard BCA for p53 protein and MDM2 protein, gene products believed to be significant in the pathogenesis of BCA. Paraffin-embedded tissue sections were immunostained with monoclonal antibody to p53 and MDM2 proteins. Strong intranuclear staining in greater than 10% of cells was considered positive. Three (50%) BPB and WDFA stained for p53 and five (83%) for MDM2. None of the PPB stained for p53, and one PPB did not stain for either p53 or MDM2. Five of six adult type PB occurred in smokers, whereas none of the PPB was associated with smoking. Seventy-five (94%) of the BCA stained for MDM2 and 46 (61%) for p53. Immunostaining patterns for p53 and MDM2 in adult types of PB, and not PPB, appear similar to those for BCA. This may suggest that adult type PB, but not childhood PB, have a similar pathogenesis to BCA.