Management and prognosis of pure primary squamous cell carcinoma of the breast.

PURPOSE: The aim of the study was to investigate the management and prognosis of Pure primary squamous cell carcinoma (PPSCC) of the breast. MATERIALS AND METHODS: This study is a multicentre retrospective cohort from three French tertiary referral hospitals (Rennes, Orléans and Tours) including all women treated for a PPSCC of the breast defined by squamous cells that could contain a minority of sarcomatoid component. We excluded carcinomas with a ductual component. Clinicopathologic, radiological and therapeutic patterns were described. Demographic, histological and therapeutic characteristics were compared to a population of women with triple negative invasive breast carcinomas. RESULTS: Twelve patients were included, with a mean age of 71.6 years. All lesions were unifocal, with a cystic complex ultrasound mass in 50% of cases. Mean tumor size was 43mm, with axillary lymph node metastasis in 25% of patients. The comparison with a population of women with triple negative breast carcinomas revealed that women with PPSCC were older (71 versus 57 years, p=0.003), tumor size was larger (43mm versus 25mm, p=0.032) and local recurrence occurred earlier (three months versus 38 months, p=0.014). CONCLUSION: PPSCC is a rare entity with a worse prognosis in comparison with triple negative invasive carcinoma.

[Diagnosis of lobular neoplasia in situ on percutaneous breast biopsy: surgical indication]. / Diagnostic de néoplasie lobulaire in situ sur biopsies percutanées: considérations chirurgicales.

UNLABELLED: The arrival of modern imagery techniques has generated an increase in diagnosed lobular intra epithelial neoplasia (LIN) cases. The aim of this research is to define standards to assess the reliability of surgical action currently advised after diagnosing LIN on percutaneous breast biopsy. MATERIALS AND METHODS: This retrospective research was conducted from January 1999 to December 2008 on 24 patients. After performing of mammotome procedure on micocalcifications, each diagnosed LIN case was reviewed by two anatomopathologists. The extent and type of LIN (1 and 2) tumor was defined. A further analysis of the surgically removed material was carried out. RESULTS: The study has indicated three cases of underestimation (12.5%). It was CCIS. The analysis of mammotome procedure shown that the extent and type of LIN were inconstant. CONCLUSIONS: The rate of underestimation is low but it appears that the extend and type of LIN's tumor on mammotome procedure is not available for the surgical decision.

Evaluation of lumpectomy surgical specimen radiographs in subclinical, in situ and invasive breast cancer, and factors predicting positive margins.

PURPOSE: To determine the diagnostic performance of radiological evaluation of the margins of surgical specimens from lumpectomies for subclinical malignant breast lesions. MATERIALS AND METHODS: Retrospective study in two French hospitals including all patients who had a non-palpable in situ (ISDC) or invasive (IDC) ductal carcinoma treated by lumpectomy after radiological localisation. For the analysis, the lesions were divided into two groups depending on the majority component in the definitive histological examination: ISDC or IDC. The radiological margin considered was 10mm. RESULTS: For the 178 lumpectomies studied, the sensitivity of the radiographs of the surgical specimen was 33.3% for ISDC and 50% for IDC. The surgical revision rate was 27.41% for ISDC and 12.64% for IDC. The significant predictive factors for positive margins were the radiological size of the lesions (>10mm) for ISDC (P=0.02) and radiologically positive margins for IDC (P=0.01). Correlation was found between the histological and radiological sizes of the lesion for IDC, but not for ISDC. CONCLUSION: Radiological examination of surgical specimens does not provide a satisfactory evaluation of the histological margins, in particular for ISDC, even with a radiological threshold of 10mm.

[Specimen radiography assessment of surgical margins status in subclinical breast carcinoma: a diagnostic study]. / Évaluation radiographique du statut des marges de résection dans le carcinome in situ du sein: une étude diagnostique.

OBJECTIVE: This study aimed to determine the accuracy of specimen radiography in evaluating the surgical margins of impalpable breast carcinoma. DESIGN AND SETTING: Retrospective study from June 2009 to June 2010 in Orleans Hospital Center. PATIENTS AND METHODS: The study involved patients with impalpable in situ breast carcinoma diagnosed by mammography. Only patients with larger in situ carcinoma than invasive carcinoma were included. Patients underwent a breast conserving surgery after preoperative localization of the lesion. PRIMARY ENDPOINT: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the specimen radiography are determined by correlation between radiologic and histologic margins. RESULTS AND DISCUSSION: The following results were obtained from 46 patients: 36 DCIS cases (78%), six DCIS with IDC cases (13%), two LCIS cases (4%) and two biopsy suggested DCIS (4%). A radiologic margin of 2mm (by analogy with the histological margins) results in a NPV of 73%. NPV, sensibility and specificity were respectively 79, 60 and 74% for a radiologic margin of 5mm. The measure or inter-rater reliability found a moderate agreement (kappa: 0.62). The systematic review on this topic found only eight articles (small samples and only two prospective studies). We could not make any recommendations from the literature review on a threshold to define excision margin status. CONCLUSION: The specimen radiography is a useful tool to assess margins of impalpable breast carcinoma. However, further studies are necessary as this point to determine a threshold for those radiologic margins.

[Mucocele-like lesions of the breast: management after diagnosis on ultrasound guided core biopsy or stereotactic vacuum-assisted biopsy]. / Mucocèles du sein: conduite à tenir après diagnostic sur micro- ou macrobiopsie.

OBJECTIVES: Clinical and pathological features of mucocele-like lesions in the breast are well-known though rare. The aim of this study is to evaluate the frequency of other breast proliferations association, the underestimation with ultrasound guided core biopsy or stereotactic vacuum-assisted biopsy and its implication on patient's management. PATIENTS AND METHODS: Retrospective study conducted in the gynecology departments of Tours and Orleans between January 1997 and December 2007, reviewing the records of all patients with diagnosis of mammary mucocele-like lesion on core or stereotactic biopsy. RESULTS: Eight cases were identified, all screen-detected (mammographic abnormalities) on asymptomatic women. For the five cases diagnosed by core biopsy, initial histological examination found isolated mucocele-like lesions in four cases, and association with atypical ductal hyperplasia in the other case. Vacuum-assisted biopsy and/or surgical excision were always done finding an association with mucinous carcinoma and another case of association with atypical ductal hyperplasia. For cases diagnosed by vacuum-assisted biopsy, histological examination was almost similar to the surgical one. DISCUSSION AND CONCLUSION: High rate of associated lesions (especially atypical ductal hyperplasia) makes necessary the advice of complementary surgical excision after a diagnosis of a mucocele-like lesion on a biopsy specimen. Vacuum-assisted biopsies could have their place as a curative method in certain conditions.

Mastectomies after vacuum core biopsy procedure for microcalcification clusters: value of clip.

PURPOSE: The study was performed to substantiate the value of detecting clips in mastectomy specimens as a guide to taking pathological samples. MATERIAL AND METHODS: We performed a retrospective review of 4 cases of mastectomy required after biopsies of microcalcifications. In each case a metallic clip had been inserted at the end of the vacuum core biopsy procedure. RESULTS: The study included 7 microcalcification clusters with a mean size of 6.7mm corresponding to multifocal or relapsing ductal carcinoma in situ. Gross examination of the mastectomy specimens revealed no evidence of tumoral lesions or fibrous scar tissue. Radiographic examination of the serial slices did not detect any microcalcifications, but confirmed the presence of the clip in the 7 clusters in 4 cases. Histological examination was performed on the areas identified by the clips and detected scar tissue indicating the location of the biopsies and tumoral lesions in all the specimens. CONCLUSION: In the pathological management of mastectomy specimens following vacuum core biopsies, gross examination may reveal no abnormalities and slice radiography may fail to detect microcalcifications. In such cases, radiography of the serial slices allows localisation of the metallic clips inserted during the vacuum-assisted biopsy procedure and remains the only way for the pathologist to select mastectomy specimens for microscopic analysis.

[Hepatic splenosis: a rare etiology of hepatic nodules]. / Splénose hépatique: une étiologie rare de nodules hépatiques.

Splenosis is the autotransplantation of splenic tissue, generally after traumatic splenic rupture. Usually, the peritoneal surface is affected. The viscera are rarely involved in this graft. We report a case of intrahepatic splenosis, which presented as a liver tumour on imagery in a 55-year-old man followed for lung carcinoma and chronic hepatitis C and who had undergone a splenectomy for trauma 22 years before. The different characteristics and diagnostic methods of 16 cases of hepatic splenosis are presented from the literature. These different reports emphasize the necessity of considering splenosis in the differential diagnosis of hepatic tumours.

[Breast pilomatrixoma manifested as microcalcifications on mammography: report of two cases]. / Pilomatricomes mammaires révélés par des microcalcifications à la mammographie: à propos de deux cas.

Pilomatricoma is a benign tumor of hair follicule origin corresponding to a firm subcutaneous nodule requiring histology for diagnosis. Only few breast pilomatricomas have been reported, with imaging showing well defined nodules with microcalcifications. We report two cases of intra-mammary pilomatricomas presenting as ACR BI-RADS 4 and 5 microcalcifications, suspicious for malignant tumors. Percutaneous biopsy confirmed the histological diagnosis. Malignant pilomatricomas have been reported, suggesting that all pilomatricomas should be resected.

[Benign papilloma: is US-guided vacuum-assisted breast biopsy an alternative to surgical biopsy?]. / Les macrobiopsies échoguidées assistées par le vide peuvent-elles constituer une alternative à l'exérèse chirurgicale de papillome bénin?

The purpose of this study is to assess the value of US guided vacuum-assisted breast biopsy compared to surgery for management of intraductal papilloma. This retrospective study included 13 patients with hypoechoic nodular lesion corresponding to small benign intraductal papillomas on biopsy and visible by US. The lesions were removed using US-guided vacuum-assisted biopsy and all tissue material was reviewed at histology. The mean size of papillomas was 9.3 mm (5-16 mm). Vacuum-assisted tumor removal was considered total for all 13 lesions. Maximum follow-up was 57 months. Two patients had tumor recurrence at 22 and 28 months respectively. In one case, atypical ductal hyperplasia was present at the periphery of the papilloma, requiring complementary surgery. US-guided vacuum-assisted excision of small benign tumors such as solitary intraductal papillomas appears to be an alternative to surgical biopsy. Because of the large volume of tissue removed, total tumor excision is possible allowing detection of incidental associated lesions.

[Value of vacuum assisted biopsies under sonography guidance: results from a multicentric study of 650 lesions]. / Place des macrobiopsies mammaires assistées par le vide sous guidage échographique: étude multi-centrique de 650 lésions.

OBJECTIVE: With this retrospective, multi-centric study, the authors are showing the technique of Vacuum assisted biopsies under ultrasound guidance and comparing it with the other widely used diagnostic techniques. Material and method. Six hundred and fifty biopsies were performed between May 2000 and December 2004, on 644 patients, in 3 centres, following a unique protocol. Lesions were categorized, using the classification from Stavros, between "probably benign", "indeterminate", "probably malignant" and "malignant" Histology was validated only after review of the clinical and radiological data, as well as surgical data when available. All benign cases were included in an on-going follow-up protocol. RESULTS: We have identified 471 benign lesions and 179 malignant lesions. The mean size of the lesions was 9 mm. Three cancers were diagnosed in the cases of "probably benign lesions" and in the cases of "probably malignant lesions" 18 (27%) were inflammatory disorders. In 5 cases vacuum biopsy underestimated the pathology with regard to surgery: 2 cases of atypical duct hyperplasia (HCA) were in situ ductal carcinoma (DCIS) at surgery and 3 cases of DCIS were infiltrative ductal carcinoma (DCI) at surgery. With this technique we have avoided surgery for 71% of all women who presented an "indeterminate" or "probably malignant" condition. Specificity is excellent with no cancer detected so far among the patients with benign findings, under follow-up. CONCLUSION: Ultrasound guided Vacuum assisted biopsy is a fairly recent minimally invasive technique, with short learning curve. The ability to collect a larger volume of tissue overcomes the targeting issues on small lesions and avoids underestimation of heterogeneous and larger abnormalities and some specific at-risk lesions such as papilloma. This technique thus appears indicated in such cases because it overcomes some of the limitations of core needle biopsy and should be considered as an alternative to surgical biopsy.

[Can US-guided vacuum-assisted biopsies be an alternative to diagnostic surgery in cases of non-diagnostic core needle biopsy?]. / Les macrobiopsies echoguidées assistées par le vide peuvent-elles constituer une alternative a la chirurgie diagnostique en cas de microbiopsies non contributives?

PURPOSE: To assess US-guided vacuum-assisted biopsies in the diagnosis of suspicious sonographic breast lesions after non-diagnostic core needle biopsies (CNB). PATIENTS AND METHODS: Retrospective study of 42 females with suspicious breast lesions at US. CNB previously performed were non-diagnostic. Because of the larger sample size, vacuum-assisted biopsies were performed, instead of surgical biopsy. RESULTS: Vacuum-assisted biopsies showed 32 benign lesions. Histologic examination of the CNB showed non-specific fibrous tissue in 43% of cases as opposed to 7.1% for vacuum-assisted biopsies. The latter provided a more specific diagnosis (mainly fibrocystic breast disease). From a total of 4 lesions that were suspicious at CNB, 3 were diagnosed as malignancies after vacuum-assisted biopsy and one case was a "borderline" lesion. Three additional malignant and three additional borderline lesions were diagnosed on vacuum-assisted biopsies. In 11 cases, surgical excision was performed, and all diagnoses from vacuum-assisted biopsies were confirmed at microscopy, except in one case where it was underestimated (ADH versus DCIS). CONCLUSION: US-guided vacuum-assisted biopsy is a reliable technique. Because it provides more tissue than CNB, it can be an alternative to diagnostic surgery after non-diagnostic CNB. Indeed, it allows confirmation of the diagnosis and provides a more specific diagnosis of benign lesions. With regards to malignant and borderline lesions, it avoids the risk of false-negative CNB and overlooking carcinomas.

Pathological prognostic factors of invasive breast carcinoma in ultrasound-guided large core biopsies-correlation with subsequent surgical excisions.

Core biopsy is currently used as the initial diagnostic procedure in breast cancer. Prognostic information is required before decisions on subsequent therapy are possible. The aim of this study was to compare prognostic data observed in ultrasound-guided core biopsies and in surgical specimens. We conducted a retrospective study of a mean of 1.2 biopsies from a total of 110 consecutive malignant breast masses. Histological tumour type and grade, presence of a ductal carcinoma in situ (DCIS) component and hormonal status were evaluated. Our results showed excellent sensitivity (100%) of core biopsy for the diagnosis of breast cancer and for the assessment of tumour type (concordance of 73.6%). We also reached a reasonable level of agreement between core biopsy and surgical excision specimens for histological grading (73.1%). Underestimation of grading on core biopsy was due predominantly to underscoring of mitotic counts (32.3%). The presence of DCIS associated with infiltrative carcinomas was widely underestimated in biopsy specimens. There were good levels of agreement for oestrogen receptors and for progesterone receptors: 90.3% and 89.3%, respectively. Diagnoses were made on the basis of a small number of ultrasound-guided core biopsy specimens taken from breast masses. Grade and hormonal status were reliably evaluated.

[Value of ultrasound detection of post-Mammotome scar for preoperative localization of breast microcalcifications]. / Intérêt de la recherche échographique de cicatrice post-Mammotome pour le repérage préopératoire des foyers de microcalcifications mammaires.

PURPOSE: We attempted to find ultrasound scar subsequent to vacuum assisted breast biopsy (Mammotome system) previously performed, and to enhance its value for preoperative localization. MATERIALS AND METHODS: Our study included 34 females requiring needle localization prior to surgery. They previously had Mammotome core biopsies for clustered microcalcifications. US examination was systematically performed before insertion of the metallic marker, in order to detect a scar. Identification of the scar allowed ultrasonographic guided localization. The accuracy was correlated with histologic findings. RESULTS: Ultrasonography detected a scar in 21 of the 34 patients (63%). Among all these cases, a perfect correlation could be established between ultrasound target and histologic scar revealed by microscopic examination. CONCLUSION: Ultrasound detection of scar allows ultrasonographic guidance and can therefore be the only alternative in cases of absence or displacement of the marker clip.

[Post-vaccination granuloma due to aluminium hydroxide]. / Granulome post-vaccinal lié à l'hydroxyde d'aluminium.

Post-vaccination granulomas a well-known reaction due to aluminium adsorbed vaccines. We report three cases of children who developed subcutaneous nodules at the site of a previous injection of Tetracoq*vaccine (tetanus, diphtheria, Bordetella pertussis, poliovirus). Histologically, the lesions were characterized by a necrotizing granulomatous reaction with eosinophilic crystalline material. This material stained positively with the solochrome cyanine stain and was pink-purple. This aluminium stain enabled diagnosis of post-immunization injection-site reaction due to aluminium.

[Duodenal somatostatinomas associated with von Recklinghausen's neurofibromatosis. Apropos of 2 cases]. / Somatostatinomes duodénaux et neurofibromatose de von Recklinghausen.

Somatostatinomas are rare neuroendocrine tumors; they are essentially located in the pancreas and in the duodenum. The association with a neurofibromatosis type I is especially observed when the tumor is located in the ampulla of Vater. These tumors are not associated with a "somatostatin syndrome", but often present with gastrointestinal bleeding, abdominal pain and obstructive jaundice. The diagnosis is confirmed by immunohistochemical studies. The aim of this study is to report 2 cases of metastazing duodenal periampullary somatostatinomas associated with von Recklinghausen's disease and to discuss the prognosis of these tumors. Future genetic research are necessary as point out the familial feature of this association in one of our cases.