1/60. Fine needle aspiration cytology of mammary pseudoangiomatous stromal hyperplasia. A case report.BACKGROUND: Pseudoangiomatous stromal hyperplasia (PASH) is an unusual benign breast lesion that may occasionally present as a palpable mass. CASE: This report describes the fine needle aspiration cytology (FNAC) features of a case of mammary PASH that presented as a palpable mass. This is the second description of the FNAC features of this lesion and the first reported case in which a diagnosis of phyllodes tumor was considered. The aspirate was cellular and contained cohesive groups of cells in which there was a dual population of epithelial and myoepithelial cells. Occasional cellular stromal fragments were present, as were typical, bipolar, bare nuclei. Admixed with the bare nuclei were large numbers of plump, spindle-shaped cells, some with intact cytoplasm. Histologic examination of the excised mass showed features typical of PASH. CONCLUSION: Mammary PASH may present as a palpable mass and is likely to be encountered in FNAC specimens. This diagnosis should be considered when one is confronted with an aspirate containing cohesive epithelial groups, cellular stromal fragments and large numbers of single, spindle-shaped cells. These features on FNAC may result in consideration of a phyllodes tumor. The single, spindle-shaped cells may be a characteristic cytologic feature of PASH.- - - - - - - - - - ranking = 1keywords = breast (Clic here for more details about this article) |
2/60. A giant vascular hamartoma of the breast in a child.Vascular tumors of the breast are uncommon. Perilobular hemangiomas, the commonest histologic subtype of breast hemangiomas, constitute majority of microscopic, vascular mammary tumors. Macroscopic hemangiomas and vascular hamartomas of the breast are distinctly rare. We describe a giant, vascular hamartoma of the right breast in a five year old girl and discuss pertinent literature.- - - - - - - - - - ranking = 8keywords = breast (Clic here for more details about this article) |
3/60. 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 = 17keywords = breast (Clic here for more details about this article) |
4/60. Primary bilateral mucosa-associated lymphoid tissue lymphoma of the breast with atypical ductal hyperplasia and localized amyloidosis. A case report and review of the literature.Primary non-Hodgkin lymphoma of the breast is a rare disease. Primary mucosa-associated lymphoid tissue lymphoma is even rarer, and bilateral involvement is exceptional. We describe a case of primary bilateral breast mucosa-associated lymphoid tissue lymphoma with bilateral atypical ductal hyperplasia and bilateral localized amyloidosis in a 64-year-old woman with a history of arthritis and systemic lupus erythematosus and its clinical, histologic, and immunohistochemical features. Microscopic examination of the breast lesion showed dense periductal and perilobular small and plasmacytoid lymphocytes with eosinophilic amyloid in the vessels and the stroma. Bilateral single foci of atypical ductal hyperplasia were also noted. Fine needle aspiration showed small and large lymphocytes and plasma cells. Molecular analysis demonstrated a heavy chain immunoglobulin H gene rearrangement. flow cytometry studies showed an abnormal B-cell population. The combined histologic, paraffin immunohistochemistry, flow cytometry, and molecular results were considered diagnostic for low-grade mucosa-associated lymphoid tissue lymphoma. The patient underwent bilateral local breast radiation without other organ or site involvement.- - - - - - - - - - ranking = 8keywords = breast (Clic here for more details about this article) |
5/60. Bilateral diffuse uveal melanocytic proliferation associated with extraocular cancers: review of a process particularly associated with gynecologic cancers.We reviewed cases of a paraneoplastic syndrome in which uveal melanocytes proliferated and led to blindness. Eighteen cases were derived from the literature, and two were taken from our institution. The average patient age at the time of the diagnosis was 63 years (range, 34-89 years). There were 13 women and 7 men. In approximately half of the cases, the ocular symptoms antedated those of the inciting tumor. Most of the inciting tumors were poorly differentiated carcinomas. The most common tumors were from the female genital tract (ovary and uterus) among the women patients and from the lung among the men. Tumors from the breast were rare (one possible case), and tumors of the prostate were conspicuously absent. All five inciting tumors whose histopathology was reviewed expressed neuron-specific enolase, but none prominently expressed antigens more specific for neuroendocrine carcinomas such as chromogranin or synaptophysin. It is our experience that many general pathologists are not aware of this unique paraneoplastic syndrome. Our report is the first to document a statistically significant association between this syndrome and gynecologic cancers.- - - - - - - - - - ranking = 1keywords = breast (Clic here for more details about this article) |
6/60. gynecomastia-like changes of the female breast.OBJECTIVES: gynecomastia-like changes of the female breast are only sparsely reported and are not well defined in the literature to our knowledge. Our objectives were to determine the incidence, clinical presentation, mammographic findings, and the medical background of patients with these changes. DESIGN: Two thousand seven hundred nine female breast surgical cases from 1995 to 1999 were searched by SNOMED. Three observers further reviewed all cases with gynecomastia-like changes. Strict criteria were developed and cases that fulfilled the criteria were analyzed further. RESULTS: We found the incidence of female gynecomastia-like changes to be 0.15% (4/2709) of all female breast lesions, which represents an underestimation. patients were usually young and had an average age of 32 years. The usual clinical presentation was a palpable mass with a size ranging from about 3.5 x 2 x 2 cm to 5 x 4 x 2.5 cm. mammography showed either negative findings or a nonspecific density. Gross examination of these specimens revealed no distinct lesions. Histologically, the lesions consisted of ductal hyperplasia with periductal stromal fibrosis or edema. They were associated with fibrocystic changes in the adjacent breast. The patients had no significant medical history. CONCLUSION: We propose that the gynecomastia-like change is a specific benign entity within the spectrum of benign fibrocystic changes and that it usually occurs in young patients.- - - - - - - - - - ranking = 8keywords = breast (Clic here for more details about this article) |
7/60. gynecomastia in type-1 neurofibromatosis with features of pseudoangiomatous stromal hyperplasia with giant cells. Report of two cases.We describe the histological finding in two cases of gynecomastia in patients with von Recklinghausen's disease. The histological and immunohistochemical features of the two cases were reviewed and compared with those of five cases of gynecomastia in men without clinical evidence of neurofibromatosis. In both patients bearing von Recklinghausen's disease, the breast stroma showed features consistent with pseudoangiomatous stromal hyperplasia (PASH). It was characterised by anastomosing empty spaces lined by spindle and multinucleated giant cells which were positive with CD34 and anti-vimentin antisera and negative with anti-FVIII and CD31 antisera. In two of five of the control cases without neurofibromatosis, the mammary stroma showed focal areas with features of PASH, but no multinucleated giant cells were present in any case. PASH with giant cells should be recognised as a feature of gynecomastia in von Recklinghausen's disease. The presence of multinucleated giant cells is very unusual and, although more cases have to be studied, these cells seem to be a feature of PASH occurring in patients with von Recklinghausen's disease.- - - - - - - - - - ranking = 1keywords = breast (Clic here for more details about this article) |
8/60. Pseudoangiomatous stromal hyperplasia: presentation as a mass in the female nipple.Pseudoangiomatous stromal hyperplasia (PASH) is a benign, localized fibroblastic and myofibroblastic overgrowth that occurs almost exclusively in premenopausal women as a painless, palpable intramammary mass. The lesion has a pale, fibrous, and homogeneous cut surface, is typically well circumscribed, and may have a diameter of 2.0-15 cm. Its ramifying slits lined by flattened myofibroblastic cells are apt to be mistaken for vascular spaces, leading to an erroneous diagnosis of angiosarcoma. The etiology of the condition is unknown, but a relationship to myofibroblastoma has been postulated. Hormonal factors, too, are thought to play a developmental role. The potential for PASH to create a palpable breast mass has been only quite recently advanced in the medical literature, and it has evidently not been reported in the nipple.- - - - - - - - - - ranking = 1keywords = breast (Clic here for more details about this article) |
9/60. tamoxifen in the management of pseudoangiomatous stromal hyperplasia.Pseudoangiomatous stromal hyperplasia (PASH) is a relatively uncommon histologic finding in breast specimens. The clinicopathologic spectrum of this disease entity can range from a focal nonsignificant microscopic finding to a dominant palpable breast mass. To confirm the diagnosis, a biopsy is required primarily to distinguish PASH from a low-grade angiosarcoma. The mammographic description of PASH is a round or ovoid, circumscribed or partially circumscribed mass. The sonographic feature is a hypoechoic mass. PASH is similar to a fibroadenoma in clinical and imaging features. Progressive breast enlargement associated with engorgement, cyclical breast pain, and burning sensation is of significant concern for some women. The management of the palpable mass and associated symptoms has included excisional biopsy, often leading to recurrent excisions and even mastectomy. This report documents an impressive response to tamoxifen in a patient with PASH presenting with breast enlargement, pain, and breast masses. To our knowledge, there are no reports on the use of tamoxifen or other selective estrogen receptor modulators in the management of this benign breast condition.- - - - - - - - - - ranking = 7keywords = breast (Clic here for more details about this article) |
10/60. Pseudoangiomatous stromal hyperplasia of the breast.Pseudoangiomatous stromal hyperplasia is a benign proliferative lesion of the mammary stroma that rarely presents as a localized mass. We describe the clinical, radiologic, cytologic, and histologic features of a case of pseudoangiomatous stromal hyperplasia that presented as a rapidly growing breast lesion in a 36-year-old woman.- - - - - - - - - - ranking = 5keywords = breast (Clic here for more details about this article) |
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