Tubular adenoma of the breast in a 73-year-old Woman

A 73-year-old woman presenting with a right breast mass is described. The patient underwent lumpectomy under a diagnosis of breast cancer. However, histopathologically the surgical specimen was tubular adenoma of the breast. This is a rare benign tumor that is difficult to differentiate from breast cancer clinically, especially in elderly patients. We describe two reported cases of tubular adenoma in patients older than 65-years in Japan, as well as the present case.     

Breast metastasis: an unusual manifestation of a malignant carcinoid tumor.

A metastasis from a bronchial carcinoid tumor presented as an isolated breast mass in a 58-year-old female. A review of the English literature revealed four cases of metastatic carcinoid to the breast that presented as an isolated breast mass. In each case, radical mastectomy was performed after the lesion had been interpreted clinically and pathologically as a primary carcinoma. When the primary tumor was excised, all cases had either regional lymph node or liver involvement. A mass was the usual presenting sign of the metastatic deposit. No metastasis was reported to be greater than 2 cm in diameter. No axillary lymph nodes were reported to contain tumor. Frozen section preparations may not be adequate to differentiate a primary carcinoma of the breast from a metastatic carcinoid tumor, thereby necessitating permanent sections, special stains, review of previously resected neoplasms, or electron microscopy. The first mammogram of a metastatic carcinoid to the breast is reported with this case.     

Mammographic and sonographic features of tubular breast carcinoma

AIMS AND BACKGROUND: This study aimed to describe the mammographic and sonographic features of tubular carcinoma of the breast. METHODS: A retrospective review of 198 consecutive cases of surgically proven breast cancer revealed ten cases of tubular carcinoma of the breast. Only tumors with a tubular component of at least 75% were included in the study. Mean patient age was 56 +/- 9 years, range 35 to 70 years. RESULTS: The mean size of the tumors was 11 +/- 4 mm. On mammography, all tubular carcinomas appeared as an irregularly shaped mass with a central density in 6/10 cases. Eight tubular carcinomas were described as having spiculated margins. Microcalcifications were present in 4/10 cases. On ultrasound the tumor presented as a hypoechoic mass with irregular margins and posterior acoustic shadowing in 7/10 cases. In three cases the tumor presented as a hypoechoic mass with ill-defined margins and posterior acoustic shadowing. CONCLUSIONS: Although some specific mammographic and sonographic features may suggest the presence of a tubular carcinoma, the final differential diagnosis from other spiculated lesions of the breast should rely on histologic evidence only. Therefore, surgical biopsy should be recommended in all cases of stellate lesions of the breast detected at mammography or ultrasonogram.     

A case of fibromatosis of the breast

A 36-year-old woman presented with a 10 mm diameter mass in the right breast. Since the mass persisted for 3 months after detection and mammary carcinoma was suspected based on ultrasonographic findings, the mass was resected. Histologically, the mass demonstrated proliferative margins and consisted of spindle cells with bland cytologic features and abundant collagen. Immunohistochemically, the spindle cells were positive for vimentin and smooth muscle actin, and were negative for cytokeratins and desmin. Furthermore, the cells showed MIB-1 immunoreactivity with a MIB-1 labeling index of 4.1. Based on these findings, was diagnosed fibromatosis. Breast fibromatosis is rare and is usually misdiagnosed as breast carcinoma preoperatively. To date, only 10 cases of breast fibromatosis have been reported in Japan. Among the reported cases in Japan, our patient presented with the smallest mass, and ultrasonographic findings in this case were the same as those of other cases. Our experience and a review of the literature indicated that differentiation of fibromatosis from carcinoma is very difficult by ultrasonographic examination. In our case, despite involvement of the surgical margins, there was no recurrence. This may be attributed to the small size of the mass and focal exposure.     

Parenchymal leiomyoma of the breast: a case report with special reference to magnetic resonance imaging findings and an update review of literature

Parenchymal leiomyomas of the breast are extremely rare, with only 25 cases reported in the literature. We report the 26th case of parenchymal leiomyoma of the breast in a 63-year-old woman who presented to us with a right breast tumor detected on her screening mammography. This tumor was evaluated by mammography, ultrasonography, and MR imaging. To the best of our knowledge, this is the first case of a parenchymal leiomyoma of the breast examined by MR imaging. MR imaging revealed an oval mass with circumscribed margins that appeared as a high-intensity lesion in both T1 and T2. A dynamic MRI study showed a gradual increase pattern on the mass. Excisional biopsy revealed a growth pattern of interlacing fascicles of spindle cells without atypia or mitoses, consistent with parenchymal leiomyoma of the breast. Here we report a case of parenchymal leiomyoma of the breast, and describe the clinical, pathological, and immunohistochemical findings. In addition, we review the literature on parenchymal leiomyoma of the breast with regard to clinical characteristics and pathological features of this entity.     

Adenoma of the breast: histopathological study of 9 cases

Adenomas of the breast are cellular epithelial lesions, which are subclassified into two types, tubular adenomas (TA) and lactating adenomas (LA). In 3365 cases of benign epithelial tumors of the breast, including fibroadenomas, filed in the Hiroshima Tumor Tissue Registry between 1973 to 1985, only nine adenomas (TA-4, LA-5) or 0.3% were filed. All adenoma cases involved females, with an average of 27.4 years. Grossly, the tumors were found to vary from 1.5 to 5 cm in diameter and were sharply demarcated. Microscopically and ultrastructurally, the small tubules found in TA are identical to normal ducts. According to progress from pregnancy to lactation, the tubular tissue in LA demonstrate breast increasing secretory activities. The absence of TA during pregnancy, the structural similarity and the fact that some LA had already developed into a palpable mass before pregnancy are signs that indicate that all TA and LA share the same biologic process.     

Tubular breast cancer experience at Washington University: a review of the literature

Our objective was to review the presentation and management of patients with tubular breast cancer treated at Barnes-Jewish Hospital and compare our findings with the available literature. Of 3908 cases of breast cancer treated at our institution between 1986 and 1995, the incidence of tubular breast cancer at Barnes-Jewish Hospital was 1.25%. We reviewed the breast cancer risks, initial presentation, treatment, and outcome of 39 women with 40 tubular breast cancers and compared our series with others in the literature. The mean patient age was 67 years, which is older than most other series. Twenty-nine of the 39 cancers (74%) were detected by screening mammography; the remainder presented with a palpable breast mass. The mean tumor size was 8 mm (range, 1-60 mm). Twenty-three of 25 tumors were ER+ (92%) and none had axillary nodal involvement. Bilateral breast cancer developed in 3 patients (8%). An additional 500 cases of tubular breast cancer have been described in the literature. When the component of the invasive tumor is > 75% tubular carcinoma, most patients present with early-stage disease that is ER+ in 47 of 56 tumors (84%). The natural history is indolent and metastases are rare. Bilateral breast cancer developed in 58 of the 540 cases (11%), 4 of which were tubular carcinomas. Local recurrences developed in 9 of 29 patients (31%) treated by excision alone. The role of tamoxifen has not been determined. Given the available data, the initial surgical staging and management of tubular carcinoma should be identical to other invasive histologies.     

Primary malignant lymphoma of the breast: Mammographic and ultrasonographic findings

Malignant lymphoma rarely involves the breast. We describe four cases of primary breast lymphoma encountered in our institution from 1979 through 1996, focusing on mammographic and ultrasonographic findings. The lymphomas were demonstrated by mammography as a well-defined mass in one case, an ill-defined mass in two cases and as diffuse increased opacity in one case. No desmoplastic change or calcification was noted. In 3 cases ultrasonography was used, revealing hypoechoic masses with (1 case) or without (2 case) posterior enhancement. During the past two years, 45 of 197 cancers (23%) were demonstrated as a mass without desmoplastic change or calcification by mammography and ultrasonography at our institution. It can be difficult to distinguish malignant lymphoma from more common diseases of the breast, such as carcinoma, by mammography and ultrasonography.     

Phyllodes tumor arising in ectopic breast tissue of the axilla

We examined a 31-year-old woman with a solid mass in her left axilla. Physical examination and ultrasonography confirmed a 2 cm well-defined mass. Fine needle aspiration biopsy suggested fibroadenoma of breast. Excisional biopsy revealed benign phyllodes tumor of the ectopic breast tissue. Phyllodes tumor in ectopic breast tissue is an extremely rare occurrence. Only nine cases have been reported, including tumors of the vulva, inguinal region and axilla. This is the second case in the axillary region.     

Pathogenesis and treatment of Paget's disease of the breast

Fifty cases of Paget's disease of the breast treated surgically at The Johns Hopkins Hospital during the past 30 years were studied. Nineteen patients had Paget's disease confined to the nipple and 31 had an associated palpable tumor. An underlying intraductal or infiltrating duct carcinoma of the breast was present in each case. In six cases, the underlying tumor was 2 cm or more from the nipple with no apparent anatomic connection to the Paget lesion, and one case was encountered in whom intradermal Paget's disease develop in the area of a congenitally absent nipple. These findings support the theory of an intradermal origin for the Paget cell. Survival rates of patients with Paget's disease and a palpable breast mass were similar to those of patients with infiltrating duct carcinoma, the presence of axillary node metastases being the most important prognostic factor. Actuarial five- and ten-year survival rates were 22% and 9.9% for patients with positive nodes. The modified radical mastectomy is recommended as primary therapy for this group of patients. In contrast, none of the patients with Paget's disease of the nipple and no evidence of a palpable breast mass developed recurrent carcinoma. A total mastectomy without an axillary node dissection is the treatment of choice in this type of patient.     

数字断层融合技术对乳腺癌的诊断价值

目的探讨数字断层融合技术（DTS）对乳腺癌的诊断价值。方法应用数字断层融合和X线钼靶检查30例临床诊断或穿刺证实为乳腺癌的患者,比较检测结果准确性。结果30例乳腺癌患者中,DTS检出24例,占80．0％;X线钼靶检出20例,占66．7％,两者之间差异无统计学意义（χ^2=0．90,P〉0．05）。其中DTS检出肿块21例,钙化9例,毛刺14例,腋窝淋巴结肿大9例;X线钼靶检出肿块13例,钙化12例,毛刺10例,腋窝淋巴结肿大3例。结论数字断层融合技术在乳腺癌的影像学诊断中是可行的,其在肿块及腋窝淋巴结的检测方面较X线钼靶好。     

Breast metastasis from renal cell carcinoma: rare initial presentation of disease recurrence after 5 years

Metastasis to the breast from extra-mammary tumors is rare with only a few sporadic cases reported. We present a 58-year-old female patient diagnosed with renal cell carcinoma. Five years ago she had a radical nephrectomy and was free of disease, then discovered solitary breast mass following self-examination. The patient presented to the breast clinic for evaluation whereupon the breast mass was identified on physical and radiological examinations. Fine needle aspiration was diagnostic of metastatic renal cell carcinoma and subsequent imaging studies demonstrated multiple pulmonary deposits and recurrent renal mass in the tumor bed of the diseased site. In a multidisciplinary clinic, the patient was elected for excision biopsy followed by systemic tyrosine kinase inhibitor therapy. Six months later she had brain metastasis and received whole brain irradiation followed by palliative therapy. We are presenting this rare case with the aim of increasing awareness of breast secondaries.     

A case report of tubular adenoma of the breast

Pure adenoma of the breast was seen in a 34-year-old Japanese woman. On examination, there was a firm, movable, nontender mass, 2.0 cm in diameter, in the upper outer quadrant of the left breast. The xeromammographic and macroscopical diagnosis was fibroadenoma. Histological examination, however, identified pure tubular adenoma of the breast. This was reported herein because of its extreme rarity.     

隐匿性乳腺癌7例临床分析及文献复习

背景与目的：隐匿性乳腺癌是临床较少见的特殊类型乳腺癌,本文拟就其诊断、治疗和预后作一探讨。方法：选择自1990年5月-2001年5月在我院胸外科收治的7例隐匿性乳腺癌的临床资料进行回顾性分析。结果;本组全为女性,占同期乳腺癌的0.59%,临床症状以腋下肿块为首发症状,体查双乳均未解及明显肿块。术前行腋下肿块或细针穿刺,均找到癌细胞。本组全作乳腺钼靶X线照片,1例考虑乳腺癌可能。3例作双乳B超检查,1例考虑乳腺癌。本组5例行Halsted根治术,2例行良改根治术,术后4例在乳腺大体标本找到原发病灶,3例为浸润性导管癌,1例为导管内癌。术后2例予辅助化疗加放疗,5例予辅助化疗,4例予口服三苯氧胺治疗。本组全部随访,均仍生存,3例生存巳超过2年半,最长1例生存巳达7年。结论：临床上对女性腋窝肿块应高度警惕隐性乳腺癌的可能,术前予细针穿刺、腋下肿块活检（或加ER、PR检测）对帮助诊断有好处;乳腺钼靶照片和乳腺B超对乳腺原发病灶的检出率较低,多需术后乳腺大体标本病理切片确诊。治疗方法多采用乳腺癌根治术或改良根治术,术后辅以化疗、放疗等综合治疗,预后优于或相似于乳腺内肿块且伴有腋下淋巴结转移的乳腺癌。     

血清蛋白质谱诊断模型在乳腺癌辅助诊断中的价值

目的 建立乳腺癌的血清蛋白质谱诊断模型,评价其在乳腺癌辅助诊断中的价值.方法 应用表面增强激光解析电离飞行时间质谱(SELDI-TOF-MS)技术检测113例乳腺癌患者、103例乳腺良性肿瘤患者及92例健康女性的血清蛋白质谱,采用Biomarker Pattern(BPS)软件分析蛋白质谱,建立分类树模型,然后对模型进行盲筛验证.结果 比较乳腺癌患者与健康女性的血清蛋白质谱,筛选出12个差异蛋白质峰.经验证,所建立的分类树模型Ⅰ诊断乳腺癌的灵敏度为91.9%,特异度为81.2%.比较乳腺良性肿瘤患者与健康女性的血清蛋白质谱,筛选出11个差异蛋白质峰.经验证,所建立的分类树模型Ⅱ诊断乳腺良性肿瘤的灵敏度为87.9%,特异度为81.2%.比较乳腺癌与乳腺良性肿瘤患者的血清蛋白质谱,筛选出2个差异蛋白质峰.经验证,所建立的分类树模型Ⅲ诊断乳腺癌的灵敏度为81.8%,特异度为78.3%.应用这些差异蛋白及分类树模型,分别对93例CA15-3阴性乳腺癌患者与36例乳腺良性疾病患者的血清、20例CA15-3阳性乳腺癌患者与36例乳腺良性疾病患者的血清进行盲筛,诊断乳腺癌的敏感度和特异度分别为80.6%和91.7%、75.0%和91.7%,明显高于传统的乳腺癌标志物CA15-3,而CA15-3阴性与CA15-3阳性乳腺癌未见明显的差异蛋白质峰.结论 应用SELDI-TOF-MS技术可筛选出乳腺癌、乳腺良性肿瘤和健康女性血清蛋白质谱存在的差异蛋白质峰,据此建立的诊断模型可用于乳腺癌的辅助诊断.     

Risk factors for uncommon histologic subtypes of breast cancer using centralized pathology review in the Breast Cancer Family Registry

Epidemiologic studies of histologic types of breast cancer including mucinous, medullary, and tubular carcinomas have primarily relied on International Classification of Diseases-Oncology (ICD-O) codes assigned by local pathologists to define histology. Using data from the Breast Cancer Family Registry (BCFR), we compared histologic agreement between centralized BCFR pathology review and ICD-O codes available from local tumor registries among 3,260 breast cancer cases. Agreement was low to moderate for less common histologies; for example, only 55 and 26 % of cases classified as mucinous and medullary, respectively, by centralized review were similarly classified using ICD-O coding. We then evaluated risk factors for each histologic subtype by comparing each histologic case group defined by centralized review with a common set of 2,997 population-based controls using polytomous logistic regression. Parity [odds ratio (OR) = 0.4, 95 % confidence interval (95 % CI): 0.2-0.9, for parous vs. nulliparous], age at menarche (OR = 0.5, 95 % CI: 0.3-0.9, for age ≥13 vs. ≤11), and use of oral contraceptives (OCs) (OR = 0.5, 95 % CI: 0.2-0.8, OC use >5 years vs. never) were associated with mucinous carcinoma (N = 92 cases). Body mass index (BMI) (OR = 1.05, 95 % CI: 1.0-1.1, per unit of BMI) and high parity (OR = 2.6, 95 % CI: 1.1-6.0 for ≥3 live births vs. nulliparous) were associated with medullary carcinoma (N = 90 cases). We did not find any associations between breast cancer risk factors and tubular carcinoma (N = 86 cases). Relative risk estimates from analyses using ICD-O classifications of histology, rather than centralized review, resulted in attenuated, and/or more imprecise, associations. These findings suggest risk factor heterogeneity across breast cancer tumor histologies, and demonstrate the value of centralized pathology review for classifying rarer tumor types.     

Stromal sarcoma with features of giant cell malignant fibrous histiocytoma

We report a case of primary giant cell malignant fibrous histiocytoma (GCMFH) of the breast. A 56-year-old Japanese woman presented with a firm mass in the right breast. Mammography and ultrasonography revealed a well-circumscribed and lobulated mass in the upper outer quadrant of the right breast, indicative of a benign breast tumor or mucinous carcinoma. Magnetic resonance imaging revealed a restricted breast tumor without intraductal spread. Computed tomography and bone scintigraphy found no sites of distant metastases. Fine needle aspiration biopsy showed several clusters of atypical cells associated with numerous multinucleated giant cells. Breast-conserving surgery with axillary lymph nodes dissection was performed. Histological examination showed primary GCMFH of the breast. No metastases were identified in any of the 15 left axillary lymph nodes resected and surgical margins were free from tumor cells. The tumor was negative for both estrogen and progesterone receptor. Neither adjuvant chemoendocrine therapy nor postoperative radiotherapy was given, and the patient has remained disease free for 30 months postoperatively. To our knowledge, only 30 cases of primary MFH of the breast have been reported in the literature.     

Two Cases of Lipid-Secreting Carcinoma of the Breast: Case Reports with an Electron Microscopic Study

Two very rare cases of lipid-secreting carcinoma of the breastare reported, together with a review of the literature. Bothpatients were Japanese women aged 70 and 81 years, respectively.In each, a mass had been found in the breast, and radical mastectomieswere performed based on a diagnosis of breast cancer at an earlyclinical stage. Both resected tumors were found to be solidand localized. In them, both estrogen and progesterone receptorswere negative. Microscopically, hematoxylin-eosin staining showedthe tumor cells to have foamy and vacuolated eosinophilic cytoplasm.Lipid staining showed the vesicles in the cytoplasm of the tumorcells to be colored a flaming red and consequently recognizedas lipid droplets. An electron-microscopic study showed thatthe tumor cells contained various sizes of lipid droplets inthe cytoplasm with no degenerative changes, and suggested thatthese lipid droplets were produced and stored in the tumor cells.It would appear, from the literature that lipid-secreting carcinomashave aggressive clinical courses, but neither vascular invasionnor lymph node metastasis was seen in either of our two cases.     

A case of tubular adenoma of the breast preoperatively suspected to be an advanced cancer

A very rare case of a tubular adenoma of the breast is reported. The patient, 59-year-old woman, was admitted to hospital because of a large, left breast tumor. The tumor, 11 cm in diameter, was adhered to the surface skin. Because a malignancy was suspected, an incisional biopsy was first carried out. A pathologic examination revealed it to be a tubular adenoma, and a simple mastectomy was chosen as the operative procedure because a latent malignancy was not ruled out. The removed tumor was grossly cystic and a histological examination supported the finding that it was a non-malignant tubular adenoma.     

Tubular carcinoma of the breast (clinico-morphological characteristics)

The following four types of tubular carcinoma of the breast were identified as a result of the study of 39 cases: typical tubular carcinoma of the breast; tubular mammary carcinoma with ductal invasion; ductal invasive carcinoma with tubular structures predominating over more than half the area of section; ductal invasive carcinoma incorporating few tubular structures. A specific clinico-morphological picture and prognosis are peculiar to each type of carcinoma. Tubular carcinoma of the breast and ductal invasive tumor with predominant tubular structures have a favorable prognosis and a regional metastasis frequency of 23-28%, practically without distant metastases. Tubular carcinoma of the breast is considered an early form of ductal invasive carcinoma which develops into other histological patterns as tumor growth progresses.