1/12. Atypical medullary carcinoma of the breast with cartilaginous metaplasia in a patient with a BRCA1 germline mutation.We examined a 34-year-old premenopausal woman who had noticed a left-breast lump a month previously. She had no past history of malignancies but had a family history of breast and ovarian cancers. Her mother had suffered from ovarian cancer when aged 47 years and had died of the disease at age 52. The younger two of the patient's four aunts had developed breast cancer when they were 37 and 48 years old. A physical examination showed an ill-defined mass, 1.5 cm in diameter, located in the upper outer quadrant of the patient's left breast. mammography revealed diffuse microcalcification in both breasts but ultrasonography revealed an irregular tumorous lesion only in the left breast. Aspiration breast cytology revealed adenocarcinoma of the left breast. Modified radical mastectomy of the left breast and excision of a biopsy specimen from the right breast were carried out simultaneously. Histopathologically the left-breast tumor was an atypical medullary carcinoma with cartilaginous metaplasia, of histological grade 3, and the right-breast specimen showed fibrocystic changes with atypical ductal hyperplasia. Estrogen receptors were positive, but progesterone receptor was not detected on the tumor cells, which were immunopositive for nuclear p53 although c-erbB-2 overexpression was not observed. A nonsense germline mutation of the BRCA1 gene (exon5) was detected. The patient has been well since the operation (10 months). These findings may provide useful information about the carcinogenesis and biological behavior of BRCA1-associated breast cancers.- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
2/12. Sclerosing lobular hyperplasia of the breast after reduction mammaplasty.Sclerosing lobular hyperplasia is a uncommon benign fibroproliferative lesion of the breast similar to a fibroadenoma. It usually presents as a mass in the outer quadrant of the breast of younger women. The authors report an atypical case of sclerosing lobular hyperplasia that presented as bilateral breast masses in an elderly woman after a reduction mammaplasty. Breast masses that develop after reduction are often a result of fat necrosis, internal scarring, or organizing hematomas. Those that do not resolve warrant open biopsy because they may represent malignant or benign neoplasms.- - - - - - - - - - ranking = 6keywords = hyperplasia (Clic here for more details about this article) |
3/12. Clinicopathologic analysis of breast lesions associated with multiple papillomas.We performed a retrospective clinicopathologic study of 28 patients with breast lesions characterized by the presence of multiple (at least 5) papillomas (MPs) in at least 2 nonconsecutive blocks. All histologic sections were assessed for the presence of coexisting fibrocystic lesions, including atypical hyperplasia (atypical ductal hyperplasia [ADH] or atypical lobular hyperplasia [ALH]), lobular carcinoma in situ (LCIS), and papillary atypia (defined as nuclear hyperchromatism, stratification, and architectural complexity of a lesser degree than in papillary carcinoma). All of the lesions were compared with a set of cases in which ductal carcinoma in situ (DCIS) (n = 20) or invasive carcinoma (INV)(n = 13) was accompanied by MPs. The MP cases had a characteristic morphologic appearance, typically presenting as a mass comprising multiple adjacent ducts filled by papillomas, accompanied by dense fibrosis and intermingled with various proliferative fibrocystic lesions, particularly florid adenosis. Atypical hyperplasia was a frequent finding (in 12 of 28 cases; 43%), particularly in cases with atypical papillomas (7 of 11; 63.6%). Although contralateral lesions occurred in 4 of 28 patients (14.2%; 3 MPs and 1 INV), only 1 patient (4%) has developed ipsilateral breast carcinoma (mean follow-up, 47 months). DCIS associated with MP was typically low grade (17 of 20; 85%) and arose from areas within or immediately adjacent to preexisting benign lesions. None has recurred (mean follow-up, 41 months), although 1 patient has contralateral MP and 3 patients (23%) have developed carcinomas in the opposite breast. INVs developing in a background of (ipsilateral) MPs were mostly small (8 of 11 <2.0 cm), node negative (7 of 10), and estrogen receptor (ER) positive (8 of 8). Only 1 of 13 patients (8%) has died from disease (mean follow-up, 59 months), but 5 (38%) have developed contralateral breast lesions (including 1 MP, 1 MP-DCIS, 1 DCIS, 1 LCIS, and 1 INV). We conclude that the frequent associations with ADH, ALH/LCIS, malignant lesions, and bilaterality imply that MP may represent a marker of constitutionally increased breast cancer risk. Because carcinomas arose within or close to areas involved by preexisting benign MP lesions, it may also be appropriate to excise segments of tissue involved by MP, particularly cases with atypia, and closely monitor for contralateral disease.- - - - - - - - - - ranking = 4keywords = hyperplasia (Clic here for more details about this article) |
4/12. Invasive cystic hypersecretory carcinoma of the breast: a case report.Cystic hypersecretory lesions of the breast are rare. These breast lesions include cystic hypersecretory hyperplasia (CHH), atypical CHH, and cystic hypersecretory carcinoma (CHC). The characteristic features are dilated ducts and cysts filled with thyroid colloid-like eosinophilic secretion. Only seven cases of invasive CHC have been reported in the literature. Here, we report an additional case of invasive CHC. The histologic features of the tumor showed both micropapillary intraductal carcinoma and focal high-grade invasive carcinoma in a background of CHH. This case suggests that cystic hypersecretory breast lesions encompass a spectrum of pathologic lesions including CHH, atypical CHH, CHC, and invasive CHC.- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
5/12. Adenosis tumor of anogenital mammary-like glands: a case report and demonstration of clonality by HUMARA assay.In mammary pathology, adenosis tumor is defined as a clinically recognizable lesion that histologically primarily consists of adenosis, but also exhibits various combinations of diverse epithelial changes seen in other benign breast diseases. A lesion that occurred in the anogenital area of a 46-year-old woman and apparently arose in anogenital mammary-like glands is described and which, in our opinion, is best classified as adenosis tumor. A biopsy revealed a well-demarcated, unencapsulated lesion surrounded by compressed fibrous tissue forming a pseudocapsule. Several histological patterns within the same tumor mass were recognizable: sclerosing adenosis-like changes, variably sized microcysts and cysts, some with rare short papillary projections having hyalinized cores, rare tubular structures exhibiting epithelial features reminiscent of simple ductal hyperplasia, areas with oxyphilic (apocrine) metaplasia, and clear cell epithelial changes resembling mucinous metaplasia. decapitation secretion was notable in many lumens. Rare lumens were filled with foamy macrophages. There were also focal clear cell changes of myoepithelial cells. The stroma was paucicellular and sclerotic in some foci and composed of myofibroblasts and myxoid in others. Calponin, actins, and p63 stained myoepithelial cells. The cells in the oxyphilic (apocrine) metaplasia areas stained for mitochondrial antigen and Bcl-2. antibodies to progesterone and estrogen receptor stained approximately 50 and 20% of the epithelial cell population, respectively. Human androgen receptor gene analysis yielded a monoclonal pattern. As our case exhibited a number of patterns identical to those seen in diverse benign breast diseases, its classification as adenosis tumor seems justifiable. This cutaneous perianal lesion is indistinguishable microscopically from its mammary analogue and was clinically detectable.- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
6/12. Intraductal papilloma with bloody discharge from Montgomery's areolar tubercle examined by ductoscopy from the areola.A patient with intraductal papilloma who had abnormal bloody discharge from Montgomery's areolar tubercle underwent mammary ductography, mammary ductoscopy from the tubercle, and microdochectomy.A 43-year-old woman who was being followed-up for left breast cancer noticed bloody discharge from Montgomery's areolar tubercle of the right breast. Because the discharge continued for 2 months, further examinations were conducted. Mammary ductoscopy of Montgomery's areolar tubercle showed a normal internal duct structure. The presence of yellowish superficial lesions suggested intraductal inflammation or superficial hyperplasia of the duct epithelium. Lavage cytology revealed benign papillary lesions. Since the discharge continued and we could not completely exclude malignancy, microdochectomy was performed. Histologically a lactiferous duct was connected to Montgomery's areolar tubercle and an intraductal papilloma was seen in part and considered to have caused the bloody discharge. Bloody discharge from Montgomery's areola tubercles is extremely rare, the present case was our first experience with ductoscopy of Montgomery's areolar tubercle out of 641 cases of mammary ductoscopy performed on patients with bloody nipple discharge from 1998 to 2004. In our case, Montgomery's areolar tubercles were connected to a lactiferous duct. Although there are a few breast carcinomas that cause bloody discharge and eruption of areola, areolar preservation should be performed with the knowledge that disease may also involve the areola through the lactiferous ducts.- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
7/12. A case of mucinous spherulosis of the breast diagnosed retrospectively in FNA material.We describe for the first time the cytologic features of mucinous spherulosis (MS), a variant of collagenous spherulosis (CS) of the breast characterized by cribiform structures containing lightly basophilic material, embedded in a loosely mucinous acellular background. Histologically, the lesion was part of a complex hyperplasia containing foci of sclerosing adenosis, and foci of atypical ductal hyperplasia (ADH). Immunohistochemical study showed reactivity with smooth muscle actin and focally for cytokeratin 14. Cytologic features of MS were recognized retrospectively and consisted of intermediate to large round hyaline spherules, naked or surrounded by myoepithelial cells. A fibrillary radial appearance was observed with Diff-Quick stain.We draw attention to the importance of recognizing these features because they can easily pose problems either by being overlooked or overdiagnosed as mucinous carcinoma. Differential diagnosis is briefly discussed.- - - - - - - - - - ranking = 2keywords = hyperplasia (Clic here for more details about this article) |
8/12. Sclerosing adenosis of the prostate.A 76-year-old man with frequency, dysuria, and urinary incontinence underwent a transurethral resection of the prostate. On microscopic examination, three prostatic chips had a proliferation of irregular crowded acini, small nests, and single cells within a cellular stroma, which created an infiltrative pattern that was though by some observers to represent carcinoma. The acini were lined by columnar, and focally, by basal (myoepithelial) cells; the latter were more clearly demonstrated with immunoperoxidase stains for cytokeratin and S100 protein. In our opinion, the lesion represents a rare variant of benign prostatic hyperplasia analogous to sclerosing adenosis of the breast.- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
9/12. Pseudoangiomatous hyperplasia of mammary stroma. Some observations regarding its clinicopathologic spectrum.Pseudoangiomatous hyperplasia of mammary stroma (PHMS) is a benign proliferation of keloid-like fibrosis, containing slit-like pseudovascular spaces. Its main importance is its distinction from angiosarcoma; however, the clinicopathologic spectrum of PHMS remains incompletely described. We report two new cases and describe our findings in 200 consecutive breast specimens evaluated for the presence of PHMS. The first patient presented with peau-de-orange change in the overlying breast skin, thus mimicking inflammatory breast carcinoma. Furthermore, this patient's PHMS lesion had been diagnosed and treated inappropriately as a low-grade angiosarcoma. The second case showed the more typical, fibroadenoma-like presentation of PHMS. In addition, PHMS changes occur commonly in routine breast biopsy specimens. In fact, our review of 200 consecutive breast specimens showed PHMS in at least one microscopic focus in 23% of cases. The PHMS changes occurred in younger patients than the control population and were associated with fibrocystic changes, in fibroadenomas, in gynecomastia, in normal breast tissue, and in sclerosing lobular hyperplasia. Ultrastructural and immunohistochemical studies of one case showed that the capillary-like spaces were either acellular or lined by fibroblasts. Pseudoangiomatous hyperplasia of mammary stroma represents a clinicopathologic spectrum, extending from focal, insignificant microscopic changes to cases where PHMS produces a breast mass. Increased awareness of PHMS and its clinicopathologic spectrum will allow its differentiation from other vascular tumors of the breast, especially low-grade angiosarcoma.- - - - - - - - - - ranking = 7keywords = hyperplasia (Clic here for more details about this article) |
10/12. female type cystic hyperplasia in a male breast.A 28 year old man had a swelling of the right breast. He was phenotypically and karyotypically a normal male. Microscopic examination of the excised specimen showed the pattern of cystic hyperplasia identical to that commonly seen in the female breast. Numerous cysts were grouped in a lobular pattern and their lining showed apocrine metaplasia. There was extensive background fibrosis, some mammary duct ectasia and some features consistent with the more classical microscopic appearances of gynaecomastia. Whilst some of the features noted above are sometimes seen in gynaecomastia the presence of the full range of the features of cystic hyperplasia is distinctly unusual in the male.- - - - - - - - - - ranking = 6keywords = hyperplasia (Clic here for more details about this article) |
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