Radial scars of benign and malignant breasts: comparative features and significance

From a study of tissue from 34 cancerous breasts and 34 benign breasts the nature and occurrence of radial scars has been assessed. The frequency of detection was influenced more by the amount of tissue assessed and by the diligence of search than by any association with cancer. Bilaterality and multifocality were features in cancerous and benign breasts and a similar range of scar histological appearance was apparent in both types. The histological features of 103 radial scars were tabulated to compare the association of characteristics within individual scars, and the information used to formulate modes of development and progression. The 'early' stage appeared to correlate with central chronic inflammatory response, many spindle cells and minor fibroelastotic distortion of parenchyma; the 'late' stage showed few spindle cells and dominant fibroelastosis with considerable distortion and separation of parenchymal elements. No support was found for the concept that the lesion is premalignant. Rather it belongs to the spectrum of sclerosing alterations affecting the breast parenchyma which ranges from physiological through to clearly pathological changes. Position in the spectrum depends upon the extent and degree of change.     

The prevalence of carcinoma in situ in normal and cancer-associated breasts

Two hundred ninety-two human breasts were examined in toto by a subgross sampling technique with histologic confirmation. The samples consisted of 185 breasts from random autopsies, 63 cancer-containing breasts, and 44 breasts contralateral to cancer-containing breasts. The method permits the identification and enumeration of essentially all of the dysplastic, hyperplastic, and neoplastic lesions present in each breast. Emphasis was on the prevalence within each sample category of ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and epithelial proliferative lesions with severe atypia, previously termed ALA 4 and ALB 4, which correspond to the clinicopathologic entities atypical ductal hyperplasia and atypical lobular hyperplasia, respectively. Additional primary foci of DCIS (unrelated to invasive breast carcinoma, if present) were found in 52.5 per cent of cancer-containing breasts, and were seen in 47.7 per cent of contralateral and 5.9 per cent of the breasts from random autopsies. Lobular carcinoma in situ was generally seen only in association with infiltrating carcinoma, usually of the ductal type. No LCIS was seen in the breasts from random autopsies. These trends are the same if the proliferative lesions with severe atypia are included with carcinoma in situ. The numbers of lesions were also markedly greater in affected cancer-associated breasts than in affected breasts obtained from autopsies. These findings suggest that LCIS, although a rare lesion in the general population, may be a significant marker for clinical carcinoma. They support previous studies showing a small percentage of women with undetected DCIS of uncertain clinical and biological potential. The multicentric nature of preinvasive breast carcinoma is further substantiated. Finally, when the prevalence and number of lesions are considered in association with the ages of the patients, the lower prevalence of such lesions in the older patients in each sample suggests that at least some DCIS and LCIS may be dependent on a premenopausal hormonal milieu for their continuing existence.     

Excision biopsy findings of patients with breast needle core biopsies reported as suspicious of malignancy (B4) or lesion of uncertain malignant potential (B3)

AIMS: The UK National Health Service Breast Screening Programme has proposed five categories for reporting breast needle core biopsies. The majority of cores are reported as benign (B1), normal (B2) or malignant (B5). The predictive value of the two borderline categories suspicious of malignancy (B4) and lesion of uncertain malignant potential (B3) was studied. METHODS AND RESULTS: Over a 2-year period a total of 3822 breast needle core biopsies were performed, with 2997 from symptomatic patients and 825 from women undergoing mammographic screening, including 43 B4 reports (40 patients) and 120 B3 reports (116 lesions in 115 patients). The frequencies of B4 (2.5% versus 0.7%) and B3 cores (7.3% versus 2.0%) were both higher in screening than in symptomatic patients. B4 was most commonly used for small fragments of atypical cells separate from the main core or focal atypical intraductal proliferations. The criteria for calling a core B3 were: atypical intraductal epithelial proliferations (including foci that in excision specimens would be classified as atypical ductal hyperplasia), lobular neoplasia, radial scar, papillary lesion, fibroepithelial lesion with cellular stroma and spindle cell proliferations. Excision biopsies were performed in 39 patients with B4 core and 96 with B3 core. Invasive carcinoma or ductal carcinoma in situ was seen in 33 of the patients with B4 (85%) and in 29 of those with B3 cores (25%). Some categories of B3 core were associated with a higher rate of malignancy (40% for atypical intraductal epithelial proliferations and 46% for lobular neoplasia). CONCLUSIONS: The positive predictive value for carcinoma is high following a B4 core (86%). The lesion should be excised, but definitive cancer treatment is not appropriate. In some cases a definite diagnosis of malignancy can be made on repeat core. The B3 group is more heterogeneous and has a lower rate of malignancy on further biopsy (25%). The majority of B3 lesions require excision. All these patients should be discussed at multidisciplinary meetings.     

Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Aims: Breast needle core biopsy (NCB) is now a commonplace diagnostic procedure in breast cancer screening, providing accurate diagnoses of both benign and malignant lesions. However, NCB may result in the borderline diagnoses of lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4). The aim was to study a large series of B3 cases from population‐based screening subjects in order to evaluate positive predictive values (PPVs) for malignancy. Methods and results: The results of 523 NCBs of women screened over a 7‐year period (1999–2006) in the East Midlands region, UK, with a B3 diagnosis who underwent surgical excision, were reviewed and compared with the final excision histology. Five percent of NCBs were reported as B3. The most frequent histological subtypes were atypical intraductal epithelial proliferation (AIDEP) and radial scar/complex sclerosing lesion (RS/CSL). Final excision histology was benign in 417 (80%) and malignant in 106 (20%) subjects (60 ductal carcinoma in situ and 46 invasive carcinoma). Lesion‐specific PPVs were as follows: AIDEP 32%; lobular neoplasia (LN) 30%; RS/CSL with AIDEP or LN 24%; RS/CSL without atypia 9%; papillary lesion with AIDEP or LN 36%; and papillary lesion without atypia 4%. Five of the 32 fibroepithelial lesions with cellular stroma were phyllodes tumours (four benign and one borderline). None of the five mucinous lesions on NCB was malignant. Conclusions: Our results show that approximately one‐fifth of NCB of screen‐detected breast lesions classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between different histological subtypes.     

Carcinoma and atypical hyperplasia in radial scars and complex sclerosing lesions: importance of lesion size and patient age

One hundred and twenty-six radial scars and complex sclerosing lesions from 91 women were examined to determine the incidence of and the clinical and pathological factors associated with the development of carcinoma and atypical hyperplasia within them. There was a clear relationship between the presence of carcinoma and atypical hyperplasia and the size of the lesion. This was not, however, a progressive relationship, there being a cut-off point about 6-7 mm. below which carcinoma was very uncommon and above which it was relatively frequent. A similar relationship was seen with patient age. Carcinoma was not seen in lesions removed from women under 40, was rare in the decade 41-50 and was relatively common above this age but with no further increase in the over 60s. A significantly higher incidence of carcinoma and atypical hyperplasia was encountered in scars detected by mammographic screening and could be explained by lesion size and the ages of the patients from which they were removed. No relationship was found between the presence of carcinoma within radial scars and complex sclerosing lesions and the existence of carcinoma in the residual breast tissue when direct extension was excluded. The carcinomas identified in the scars were of variable type and included small and large cell ductal carcinoma in situ, lobular carcinoma in situ and invasive carcinoma of tubular and ductal types. In situ carcinoma and atypical hyperplasia involved a very variable percentage of the epithelium of the lesions with mean values for ductal carcinoma in situ of 32%, lobular carcinoma in situ 25% and atypical hyperplasia 25%. It is concluded that all screen-detected radial scars and complex sclerosing lesions should be excised and subjected to thorough histological examination. Further studies on larger numbers of screened women are indicated to determine more precisely the incidence of carcinoma in these lesions and the risk of developing cancer in women in whom uncomplicated scars are detected.     

Breast self-examinations: Who does them and why

In a population of 158 women with a breast concern, two-thirds examined their own breasts. Most examiners (80%) practiced breast self-examination at least once a month, and over 60% had been regular examiners for more than 2 years. No significant difference in frequency of breast self-examination was found between women who had been examiners for longer and shorter time periods. Examiners had two main reasons for beginning and continuing breast self-examination: (1) an awareness that it is desirable to detect breast cancer early and (2) an awareness that they themselves could get breast cancer, while nonexaminers tended to deny this possibility. Therefore, to become examiners, nonexaminers may need to be convinced not only that early detection is effective but also that they too are at risk of breast cancer. The importance of informing, but not alarming, women about their breast cancer risk is discussed.This work was supported by Public Health Service Grant CA 13556 from the National Cancer Institute.     

Pathology of R4 spiculated lesions in the breast screening programme

Small spiculated carcinomas are indistinguishable from benign radial scar/complex sclerosing lesions on mammography, leading to a radiological assessment of R4 (suspicious, probably malignant). The cytological and pathological features of 80 screen detected R4 spiculated lesions were reviewed. The analysis showed that there were 46 radial scars, of which 38 were benign and 8 (17%) contained foci of ductal carcinoma in situ (DCIS), and 34 spiculated carcinomas. The majority of radial scars showed some degree of epithelial hyperplasia (assessed semi-quantitively) but the cellularity of the lesion as a whole was not related to the presence of DCIS. In 20 cases no aspiration was attempted for cytology but 40% were inadequate and only one lesion containing DCIS had cytology C4 or C5. Diagnosis of radial scar was made in all cases by localization biopsy. The carcinomas ranged in size between 4 and 15 mm (mean 8.9 mm) and were of grade 1 (21 = 63%) or grade 2 (12 = 37%). There were 16 infiltrating ductal carcinomas of no special type, 12 tubular carcinomas, three lobular carcinomas, two ductal and lobular mixed, and one mucinous carcinoma. Only one patient with carcinoma was node-positive. For the carcinomas, 12 (35%) yielded C5 (malignant) cytology allowing pre-operative diagnosis.     

Patterns of basement membrane deposition in benign and malignant breast tumours

We have examined epithelial basement membranes in tissue samples of seven normal breasts, 64 benign breast lesions and 63 malignant breast tumours by immunocytochemistry, using polyclonal antisera specific for type IV collagen. In normal breast tissue as well as in all benign tumours a continuous basement membrane was found at the epithelial stromal interface. In benign proliferative lesions, epitheliosis and papillomatosis could be more accurately distinguished with basement membrane staining. This approach also facilitated the differentiation between sclerosing adenosis and tubular carcinoma, since the tubules in sclerosing adenosis are surrounded by a continuous basement membrane whereas in tubular carcinoma basement membranes are almost entirely absent. In radial scar lesions the tubules were always surrounded by intact basement membranes, which underlines the fact that these are benign lesions. In breast carcinoma we could not detect a relationship between histological grade and the extent of basement membrane deposition. However, in different tumour types the basement membrane alterations varied. In infiltrating lobular carcinoma of the alveolar type, fragments of basement membrane were found, whereas in the classic and trabecular type, basement membranes were absent, suggesting that the alveolar type may be an intermediate phase in the progression of lobular carcinoma in situ to infiltrating lobular carcinoma. It is concluded that basement membrane immunocytochemistry, using antibodies to type IV collagen, is useful in the differentiation between benign and malignant breast lesions and in the classification of breast neoplasms.     

Apocrine epithelium of the breast: does it result from metaplasia?

 Benign and malignant breast lesions may show an apocrine epithelium considered to be the result of metaplasia. In an attempt to clarify the histogenesis of the breast apocrine epithelium we searched for the presence of apocrine cells or cells with apocrine differentiation during human breast development. We analysed 10 autopsy specimens of female breasts from fetuses between 28 and 40 weeks of gestational age and tissue from 6 normal breasts, obtained after breast reduction in nulliparous young women between 22 and 28 years of age. Formalin-fixed, paraffin-embedded sections were stained with haematoxylin-eosin, PAS-diastase and a monoclonal antibody (BRST-2) anti-GCDFP-15, which is a specific apocrine marker. A 40-week fetal breast was analysed by electron microscopy. No cells with histological and ultrastructural apocrine features were found in the ducts of fetal breasts. All fetal breasts showed some ducts with sparse GCDFP-15-immunoreactive cells; the number of these cells increased with gestational age. PAS-diastase was negative. No cells with apocrine morphology were found in ducts and lobules of normal adult breasts. Scattered GCDFP-15-positive luminal epithelial cells and rare PAS-diastase-positive cells were observed in some lobules of all adult breasts. Cells with biochemical characteristics (GCDFP-15 expression) of apocrine differentiation are evident during human fetal breast development and persist in adult mammary glands. Unknown stimuli may induce these cells to take on an apocrine morphology. Apocrine epithelium of the breast may be a normal process of differentiation rather than metaplasia. We suggest the term ”apocrine differentiation precursor cells” for GCDFP-15-positive breast epithelial cells with no apocrine morphology. Received: 14 February 1997 / Accepted: 12 April 1997     

Surgical excision outcome after radial scar without atypical proliferative lesion on breast core needle biopsy: a single institutional analysis

Radial scar (RS) has been recognized as a risk factor for developing breast cancer, and excision is recommended for patients with RS identified on core needle biopsy (CNB). However, recent literatures suggest that the increased risk may be caused by concurrent proliferative lesions on the biopsy, rather than radial scar itself. In this study, we investigated the follow-up excision (FUE) results for patients with RS on CNB with no history of a prior or a concurrent breast cancer or atypical proliferative lesions (APLs). A total of 113 RS cases including 32 cases with APLs or carcinoma and 81 cases without APLs on CNB were included in this study. Forty cases (49%) without APLs had FUE. No significant difference in radiologic and clinical findings was identified between cases with FUEs and cases without FUEs. Of the 40 cases with FUE, 9 cases (22.5%) were upgraded including 3 atypical ductal hyperplasias, 4 lobular neoplasias, 1 flat epithelial atypia, and 1 atypical apocrine adenosis. However, no case was upgraded to invasive carcinoma or ductal carcinoma in situ. All cases with mammotome CNBs were not upgraded. Our data suggest that conservative follow-up with imaging rather than surgical excisions may be more appropriate for patients with only RS on biopsy, especially for patients with mammotome CNBs.     

Comparison of margin assessment by radial and shave sections in wide local excision specimens for invasive carcinoma of the breast

Hodi Z, Ellis I O, Elston C W, Pinder S E, Donovan G, Macmillan R D & Lee A H S
(2010) Histopathology 56 , 573–580 Comparison of margin assessment by radial and shave sections in wide local excision specimens for invasive carcinoma of the breast Aims: Standard margin assessment of breast carcinoma surgical specimens uses radial sections perpendicular to the margin. Shave sections assess a larger surface area of margin than radial sections. The aim was to assess the value of additional shave sections of the margin. Methods and results: Both types of section were used to assess 471 wide local excision specimens for invasive carcinoma. One hundred and seventy‐nine specimens had positive margins: only radial margins were involved (tumour within 5 mm of margin) in 76, only shave margins in 45, and both shave and radial margins in 58. Residual carcinoma was found in re‐excision specimens (immediate or later) in 43% when the closest distance to the radial margin was 0–1 mm, 25% for 2–4 mm, 18% for 5–9 mm and 13% for >9 mm. Residual carcinoma was found in 44% of specimens if any shave section was positive and in 9% if all shaves were negative. Residual carcinoma was found in 32% if either radial or shave sections were positive and in 4% if neither was positive. Conclusions: The combination of radial and shave sections appears to be good at separating patients into two groups with high and low risk of residual carcinoma.     

Angiogenesis and VEGF expression in pre-invasive lesions of the human breast

Angiogenesis (as microvascular density-MVD) and vascular endothelial growth factor (VEGF) expression were evaluated by immunohistochemistry in all types of human pre-invasive breast lesion, un-associated with invasive carcinoma, including florid ductal hyperplasia of usual type (FDHUT, 40 cases), atypical ductal hyperplasia (ADH, 10), well-differentiated intraductal carcinoma (WDIC, 16), intermediately differentiated intraductal carcinoma (IDIC, 25), poorly differentiated intraductal carcinoma (PDIC, 20), atypical lobular hyperplasia (ALH, 13), and lobular carcinoma in situ (LCIS, 12). Both parameters were also studied in normal glandular structures obtained from normal breasts or from breasts containing pre-invasive lesions. Increased vascularization was present in all lesion types (MVD mean values (expressed as vessel number/mm(2)): 115 +/- 8 in normal lobules, 146 +/- 26 in lesions; p < 0.05) and increased with lesion severity. In ductal lesions, MVDs were significantly higher in PDIC (190 +/- 65) and IDIC (167 +/- 61) than in FDHUT (123 +/- 40) and ADH (122 +/- 47); MVD was much higher in PDIC than in WDIC (p < 0.001). WDIC showed peculiar features, with a degree of vascularization closer to hyperplasia than to the other histological types of in situ ductal cancer; this observation is in line with the hypothesis that IDIC and PDIC may originate 'de novo', without a mandatory transition through WDIC. LCIS was more vascularized than ALH (168 +/- 50 and 125 +/- 40, respectively; p < 0.05), showing MVD values similar to those of PDIC and IDIC. The vascularization of normal lobules was constant, regardless of their association with lesions. VEGF expression in normal glandular structures was lower than in lesions, with the highest levels found in ductal lesions when compared with lobular lesions. No correlation was found between VEGF expression and the degree and/or type of vascularization.     

Decreased apoptosis in non-involved tissue from cancer-containing breasts

Various histological changes in the breast have been associated with an increased risk of development of breast cancer; these changes have been identified in non-involved tissue in cancer-containing breasts, suggesting that factors promoting the development of carcinoma may have a field effect. Previous work has identified alterations in growth factor receptors and integrins in cancer-containing breast tissue. In the present study, proliferation and apoptosis are examined. Non-involved breast tissue from 104 women taken at least 4 cm away from a carcinoma and normal/benign tissue from 105 age-matched women were studied. Proliferation was assessed using MIB-1 immunohistochemistry and labelling for histone mRNA, as a marker of S-phase. In situ end-labelling was used to identify apoptosis; any non-labelled apoptotic bodies were also counted. No differences were found between the non-involved tissue and the control group for MIB-1 index and histone index. The apoptotic index was higher in the control group than in the cancer-containing breasts, being greater for ducts than for acini. When the apoptotic index/MIB-1 index and apoptotic index/histone index were considered, the mean for both was lower in the acini from cancer-containing breasts than in the control group, although the ratios for ducts were similar. The reduction in apoptosis may lead to the preservation of genetically aberrant cells, hence favouring neoplastic development. There is a need for further investigation of ‘at-risk’ cases, including women with a family history, and for a prospective study of a large group of women. © 1998 John Wiley & Sons, Ltd.     

Metaplastic carcinoma of the breast arising within complex sclerosing lesion: a report of five cases

AIMS: This study presents a series of five cases in which metaplastic carcinoma, predominantly low-grade adenosquamous carcinoma, of the breast is seen arising within a background of a complex sclerosing lesion. This association has been recognized previously but has not been documented in detail. This study describes the characteristics of the components present in each case and discusses the existing literature. This observation adds further evidence to support an association between some types of invasive breast carcinoma and sclerosing lesions of the breast. METHODS AND RESULTS: Four of these cases were received as referral cases for opinion. The fifth was received as part of the routine surgical workload within our own institution. Two patients presented following mammographic screening and three symptomatically; their mean age was 62 years (range 49-68). The mean lesion size was 16 mm (range 7-24). All five lesions showed features of a complex sclerosing lesion/radial scar in the form of central sclerosis with elastosis and radiating benign entrapped tubules. One had associated benign papillary structures and two had focal benign squamous metaplasia. Four cases showed coexisting but distinct areas of low-grade adenosquamous carcinoma with glandular and squamous epithelial differentiation in a spindle cell background. One case had associated undifferentiated spindle cell carcinoma. Detailed immunophenotypic characteristics of two cases are presented. CONCLUSIONS: This series illustrates a postulated but previously unconfirmed association between an unusual form of metaplastic breast carcinoma (adenosquamous carcinoma) and complex sclerosing lesions. The mechanisms of induction of breast carcinoma are poorly understood but these observations further emphasize the potential for sclerosing lesion of the breast to be associated with, and possibly give rise to, invasive carcinoma of different types. The precise nature of the interaction between the pathological processes remains unclear.     

Detection of breast abnormalities using a prototype resonance electrical impedance spectroscopy system: a preliminary study

Electrical impedance spectroscopy has been investigated with but limited success as an adjunct procedure to mammography and as a possible pre-screening tool to stratify risk for having or developing breast cancer in younger women. In this study, the authors explored a new resonance frequency based [resonance electrical impedance spectroscopy (REIS)] approach to identify breasts that may have highly suspicious abnormalities that had been recommended for biopsies. The authors assembled a prototype REIS system generating multifrequency electrical sweeps ranging from 100 to 4100 kHz every 12 s. Using only two probes, one in contact with the nipple and the other with the outer breast skin surface 60 mm away, a paired transmission signal detection system is generated. The authors recruited 150 women between 30 and 50 years old to participate in this study. REIS measurements were performed on both breasts. Of these women 58 had been scheduled for a breast biopsy and 13 had been recalled for additional imaging procedures due to suspicious findings. The remaining 79 women had negative screening examinations. Eight REIS output signals at and around the resonance frequency were computed for each breast and the subtracted signals between the left and right breasts were used in a simple jackknifing method to select an optimal feature set to be inputted into a multi-feature based artificial neural network (ANN) that aims to predict whether a woman's breast had been determined as abnormal (warranting a biopsy) or not. The classification performance was evaluated using a leave-one-case-out method and receiver operating characteristics (ROC) analysis. The study shows that REIS examination is easy to perform, short in duration, and acceptable to all participants in terms of comfort level and there is no indication of sensation of an electrical current during the measurements. Six REIS difference features were selected as input signals to the ANN. The area under the ROC curve (A(z)) was 0.707 +/- 0.033 for classifying between biopsy cases and non-biopsy (including recalled and screening negative) and the performance (A(z)) increased to 0.746 +/- 0.033 after excluding recalled but negative cases. At 95% specificity, the sensitivity levels were approximately 20.5% and 30.4% in the two data sets tested. The results suggest that differences in REIS signals between two breasts measured in and around the tissue resonance frequency can be used to identify at least some of the women with suspicious abnormalities warranting biopsy with high specificity.     

Mammographic Breast Density Evaluation in Korean Women Using Fully Automated Volumetric Assessment

The purpose was to present mean breast density of Korean women according to age using fully automated volumetric assessment. This study included 5,967 screening normal or benign mammograms (mean age, 46.2 ± 9.7; range, 30–89 years), from cancer-screening program. We evaluated mean fibroglandular tissue volume, breast tissue volume, volumetric breast density (VBD), and the results were 53.7 ± 30.8 cm³, 383.8 ± 205.2 cm³, and 15.8% ± 7.3%. The frequency of dense breasts and mean VBD by age group were 94.3% and 19.1% ± 6.7% for the 30s (n = 1,484), 91.4% and 17.2% ± 6.8% for the 40s (n = 2,706), 72.2% and 12.4% ± 6.2% for the 50s (n = 1,138), 44.0% and 8.6% ± 4.3% for the 60s (n = 89), 39.1% and 8.0% ± 3.8% for the 70s (n = 138), and 39.1% and 8.0% ± 3.5% for the 80s (n = 12). The frequency of dense breasts was higher in younger women (n = 4,313, 92.3%) than older women (n = 1,654, 59.8%). Mean VBD decreased with aging or menopause, and was about 16% for 46-year-old-Korean women, much higher than in other countries. The proportion of dense breasts sharply decreases in Korean women between 40 and 69 years of age.     

Malignant lymphoma of the breast. Immunologic type and association with lymphocytic mastopathy.

Clinical and pathologic findings in 19 cases of primary non-Hodgkin's lymphoma of the breast collected from several hospitals in Japan were reviewed. All patients were women (median age, 45 years) and they usually had breast masses that had recently become enlarged. The sites of the lesions were the right breast in eight cases, the left breast in eight, and both breasts in one. The locations of two masses were unknown. Lymphoma recurred in the opposite breast in three cases 14, 23, and 23 months after surgery. Histologically, diffuse large cell lymphoma was the most common form of disease (63%). One lesion was a follicular lymphoma. The so-called lymphoepithelial lesion, a characteristic finding for mucosa-associated lymphoid tissue type lymphomas, was observed in eight cases (42%). Immunohistochemical analysis revealed that all but two tumors were of B-cell type; such findings confirmed morphologically based conclusions. Histologic and immunohistochemical evidence of lymphocytic mastopathy, a recently described autoimmune disease of the breast, was found in most of the cases. Formation of lymphoid follicles in or around the tumors was found in five cases (26%). Based on these findings, it is suggested that most mammary lymphomas are B-cell tumors and they may be associated with coexisting or antecedent lymphocytic mastopathy.     

Nodular sclerosing adenosis (adenosis tumor) of the breast. An immunohistologic study particularly in reference to the relationship with radial cicatrix and to the differential diagnosis with tubular carcinoma

The clinical and pathologic findings of four cases of palpable sclerosing adenosis of the breast, called "adenosis tumor", are reported. Adenosis tumor is a rare lesion that clinically and sometimes histologically is misinterpreted as mammary carcinoma. In our study, adenosis tumor was detected in four women of 35-39 years (average 37 years). All cases were treated by local excision. None of the lesions had recurred at follow-up, 1-3 years later. Microscopically the most frequent growth pattern was classical sclerosing adenosis. Other findings were epitheliosis, collagenous spherulosis, microcysts, apocrine metaplasia and radial scars. Only in one case were detected foci of lobular carcinoma in situ. With immunoperoxidase staining, the proliferating cells stained positively for cytokeratin (AE1/AE3) and actin, revealing epithelial and myoepithelial differentiation. Coexpression of actin, S-100 protein and GFAP was detected in numerous stromal myofibroblast-like cells. In sclerosing adenosis and in radial scar the tubules were surrounded by a continuous intact basement membrane composed of type IV collagen, whereas in tubular carcinoma basement membranes are almost entirely absent.     

Prophylactic mastectomy: pathologic findings in high-risk patients

BACKGROUND: According to recently published data, prophylactic mastectomy (PM) appears to prevent about 90% of the expected malignant neoplasms in women with a family history of breast cancer. OBJECTIVES: To identify the frequency of high-risk lesions in PM specimens and to determine occurrence of any new primary breast cancer following PM. DESIGN: We performed a retrospective study of women undergoing unilateral or bilateral PM. Medical charts and pathologic findings of 35 patients who underwent bilateral mastectomies at University Hospital, Syracuse, NY, from 1989 to 1996 were reviewed. Patients with biopsy-proven bilateral breast cancer were excluded. Patients were divided into 3 groups: (A) positive family history and no known breast cancer (n = 9), (B) positive family history and contralateral neoplasia (n = 13), and (C) negative family history and contralateral neoplasia (n = 13). These findings were compared with those found in reduction mammoplasty specimens from 10 women at standard risk of breast cancer. RESULTS: The mean age of the control group of women undergoing reduction mammoplasty was 38 years. The pathologic specimens demonstrated no significant pathologic findings in 9 and fibrocystic change in 1. In group A, the mean number of affected relatives was 3.1, and the mean age was 38 years. Two of these 9 women had atypical duct hyperplasia and 1 had atypical lobular hyperplasia in their breasts (ie, 33% with high-risk pathologic findings). Of the 13 group B women (mean age, 46.6 years; mean of 2.5 affected relatives and unilateral breast cancer), the contralateral PM specimen contained duct carcinoma in situ in one and invasive ductal cancer in a second (15% with occult malignant neoplasms). In 13 group C patients (mean age, 47.1 years), 3 (23.1%) of the contralateral PM specimens displayed atypical duct hyperplasia or atypical lobular hyperplasia. At a mean follow-up of 4.8 years, there have been no new breast malignant neoplasms in these 45 women. CONCLUSIONS: The occurrence of unilateral cancer in patients with family history of breast cancer is associated with a 15.4% probability of simultaneous occult malignant neoplasms in the contralateral breast. Patients with a strong family history but no evidence of breast cancer have a substantially similar rate of proliferative disease in their PM specimens as those women who have unilateral cancer but no significant family history.